A retrospective study on the prognostic value of preoperative C-reactive protein to albumin ratio in patients with oral cavity squamous cell carcinoma

Abstract

Background Although the C-reactive protein-to-albumin ratio (CAR) can predict poor outcomes in assorted cancers, its prognostic value in oral cavity squamous cell carcinoma (OSCC) remains unclear. We explored the value of preoperative CAR in predicting clinical outcomes in OSCC patients treated with radical surgery. Methods All the recommended cutoff values were defined analyzing receiver operating characteristic curves or overall survival (OS). Dichotomization was performed on the basis of optimal CAR cutoff, and we compared the clinicopathological features between groups. Kaplan–Meier analysis was also performed to compare OS curves between the two groups. Univariate and multivariate analyses using the Cox proportional hazards model were conducted to find the clinical characteristics that were most closely correlated with disease free survival (DFS) and overall survival (OS). A nomogram incorporated CAR and several clinicopathological factors was established to predict prognosis and its accuracy was evaluated using concordance index (c-index). Results In this retrospective study, a total of 326 patients with newly diagnosis of OSCC and received primary surgery between 2008 and 2017 were enrolled. Through the executed ROC curve analyses, the optimal CAR cutoff derived was 0.195 (area under the curve = 0.718, p < 0.001), with this cutoff exhibiting a discrimination ability superior to that of other inflammation-based prognostic scores after comparing the area under curves. Multivariate analysis demonstrated that CAR (≥0.195/<0.195) was associated with OS (hazard ratio 3.614; 95% CI [1.629–8.018]; p = 0.002) and DFS (hazard ratio 1.917; 95% CI [1.051–3.863]; p = 0.029). Kaplan–Meier analysis and log rank test revealed a significant difference in DFS and OS curves between patients with low CAR (<0.195) and those with high CAR (≥0.195; both p < 0.001). The c-index of the nomogram based on TNM system alone was 0.684 and could be increased to 0.801 if CAR and other clinicopathological factors were included. Conclusions Preoperative CAR could constitute an independent prognostic indicator for OS and DFS prediction in OSCC patients treated with curative surgery. The established nomogram that incorporated CAR and prognostic factors might increase the accuracy of prognostic prediction for patients with OSCC.

Lymph node ratio-based nomogram for prognosis evaluation and treatment optimization of non-metastatic oral cavity squamous cell carcinoma

“…Based on this tendency, PLN surpassed the traditional AJCC N stage and sprung up as an independent variable from the MVC model. In terms of the discriminative performance of this nomogram, its C-index and AUC both significantly outperformed AJCC TNM stage and were at least comparable to previous nomograms for OCSCC [20] , [21] , [22] , [23] . On the basis of single-institution data with similar cohort identification and potential factors for selection with ours, Chen F et al [19] .…”

“…By incorporating multiple prognostic determinants, nomogram based prognostic score is more accurate and comprehensive in predicting individualized oncologic outcome and the value of PORT. Several nomograms have been developed to evaluate prognosis of OCSCC in recent years [20] , [21] , [22] , [23] . However, to the best of our knowledge, there is no LNR-based nomogram in predicting the prognosis of OCSCC or adapting PORT in OCSCC so far.…”

The value of the Advanced Lung Cancer Inflammation Index (ALI) in assessing the prognosis of patients with hepatocellular carcinoma treated with camrelizumab: a retrospective cohort study

“…P r e v i o u s s t u d i e s h a v e f o u n d t h a t c a n c e r a n d inflammation are closely related to various inflammationbased biomarkers; for example, the NLR, the platelet-tolymphocyte ratio, and the albumin-globulin ratio have been used for early prognostic assessments of several tumors, but their efficacy has been controversial in different studies (18,19). Notably, elevated C-reactive protein (CRP) has been shown to indicate an increased risk of lung and bowel cancer, and the NLR has been found to be a poor prognostic factor for several tumors (20,21).…”

Advanced Lung Cancer Inflammation Index Predicts Survival Outcomes of Patients With Oral Cavity Cancer Following Curative Surgery

“…Systemic inflammation and malnutrition are responsible for cancer growth, tumorigenesis, and metastasis, and these can be assessed by routine laboratory examinations at the time of diagnosis ( 7 , 8 ); therefore, various nutrition/inflammation-based biomarkers, such as C-reactive protein–albumin ratio (CAR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and albumin–globulin ratio (AGR), are used for early estimation of head and neck cancer (HNC) prognosis ( 9 – 12 ). In 2013, Jafri et al.…”

“…Systemic inflammation and malnutrition are responsible for cancer growth, tumorigenesis, and metastasis, and these can be assessed by routine laboratory examinations at the time of diagnosis (7,8); therefore, various nutrition/inflammationbased biomarkers, such as C-reactive protein-albumin ratio (CAR), platelet-to-lymphocyte ratio (PLR), neutrophil-tolymphocyte ratio (NLR), and albumin-globulin ratio (AGR), are used for early estimation of head and neck cancer (HNC) prognosis (9)(10)(11)(12). In 2013, Jafri et al first combined NLR, serum albumin level, and body mass index (BMI) into a unified advanced lung cancer inflammation index (ALI) and demonstrated its prognostic value in patients who had been diagnosed as having metastatic non-small-cell lung cancer (NSCLC) (13).…”