Huang Xiaoyu, Peng Gang, Kong Yaqing, Cao Xiaojing, Zhou Xiang
Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China.
J Inflamm Res. 2025 Jan 8;18:203-217. doi: 10.2147/JIR.S483208. eCollection 2025.
This study aimed to evaluate the prognostic value of C-reactive protein to albumin (CRP/Alb) ratio in hepatocellular carcinoma (HCC) treated with transcatheter intra-arterial therapy combined with molecular targeted agents (MTAs) and programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors.
Medical records of 271 consecutive patients with HCC receiving this combination therapy in China between 2019 and 2023 were retrospectively analyzed. Prognostic factors for progression-free survival (PFS) and overall survival (OS) were identified using univariate and multivariate Cox regression analyses. The discriminatory capability of inflammation-based prognostic scores-including the CRP/Alb ratio, C-reactive protein and alpha-fetoprotein in immunotherapy (CRAFITY) score, modified Glasgow prognostic score (mGPS), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII)-was assessed using the area under the curve (AUC).
A total of 133 patients met the inclusion criteria. The optimal cutoff value for the binary classification of CRP/Alb ratio in predicting OS, as determined using X-tile software, was 0.02. Multivariate analysis identified the CRP/Alb ratio (hazard ratio [HR] = 2.61, < 0.001), tumor size (HR = 2.45, = 0.018), and extrahepatic metastases (HR = 1.93, = 0.015) as independent predictors of OS. For PFS, significant factors included Eastern Cooperative Oncology Group Performance Status (HR = 1.55, = 0.033) and macrovascular invasion (HR = 1.48, = 0.046). Patients with higher CRP/Alb ratios were more likely to experience fever and fatigue. The CRP/Alb ratio demonstrated significantly higher AUCs than PLR and SII at 24 months (all < 0.05) and showed comparable AUCs to CRAFITY score and mGPS at 12, 24, and 36 months.
The CRP/Alb ratio is a valuable prognostic marker for predicting OS and treatment-related adverse events in HCC patients receiving transcatheter intra-arterial therapy combined with MTAs and PD-1/PD-L1 inhibitors. This ratio can be used as a simple and reliable biomarker for assessing prognosis and guiding patient selection in clinical practice.
本研究旨在评估C反应蛋白与白蛋白比值（CRP/Alb）在接受经动脉导管介入治疗联合分子靶向药物（MTAs）及程序性细胞死亡蛋白1（PD-1）/程序性死亡配体1（PD-L1）抑制剂治疗的肝细胞癌（HCC）中的预后价值。
回顾性分析2019年至2023年期间在中国接受这种联合治疗的271例连续HCC患者的病历。使用单因素和多因素Cox回归分析确定无进展生存期（PFS）和总生存期（OS）的预后因素。使用曲线下面积（AUC）评估基于炎症的预后评分的鉴别能力，包括CRP/Alb比值、免疫治疗中的C反应蛋白和甲胎蛋白（CRAFITY）评分、改良格拉斯哥预后评分（mGPS）、血小板淋巴细胞比值（PLR）和全身免疫炎症指数（SII）。
共有133例患者符合纳入标准。使用X-tile软件确定的CRP/Alb比值在预测OS的二元分类中的最佳截断值为0.02。多因素分析确定CRP/Alb比值（风险比[HR]=2.61，<0.001）、肿瘤大小（HR=2.45，=0.018）和肝外转移（HR=1.93，=0.015）为OS的独立预测因素。对于PFS，显著因素包括东部肿瘤协作组体能状态（HR=1.55，=0.033）和大血管侵犯（HR=1.48，=0.046）。CRP/Alb比值较高的患者更易出现发热和疲劳。CRP/Alb比值在24个月时的AUC显著高于PLR和SII（均<0.05），在12、24和36个月时与CRAFITY评分和mGPS的AUC相当。
CRP/Alb比值是预测接受经动脉导管介入治疗联合MTAs及PD-1/PD-L1抑制剂的HCC患者OS和治疗相关不良事件的有价值的预后标志物。该比值可作为一种简单可靠的生物标志物，用于临床实践中的预后评估和指导患者选择。
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