C-Reactive Protein to Albumin Ratio as Prognostic Marker in Locally Advanced Non-Small Cell Lung Cancer Treated with Chemoradiotherapy

Abstract

Despite the implementation of consolidative immune checkpoint inhibition after definitive chemoradiotherapy (CRT), the prognosis for locally advanced non-small-cell lung cancer (NSCLC) remains poor. We assessed the impact of the C-reactive protein (CRP) to albumin ratio (CAR) as an inflammation-based prognostic score in patients with locally advanced NSCLC treated with CRT. We retrospectively identified and analyzed 52 patients with primary unresectable NSCLC (UICC Stage III) treated with definitive/neoadjuvant CRT between 2014 and 2019. CAR was calculated by dividing baseline CRP by baseline albumin levels and correlated with clinicopathologic parameters to evaluate prognostic impact. After dichotomizing patients by the median, univariate and multivariate Cox regression analyses were performed. An increased CAR was associated with advanced T-stage (p = 0.018) and poor performance status (p = 0.004). Patients with pre-therapeutic elevated CAR had significantly lower hemoglobin and higher leukocyte levels (hemoglobin p = 0.001, leukocytes p = 0.018). High baseline CAR was shown to be associated with worse local control (LPFS, p = 0.006), shorter progression-free survival (PFS, p = 0.038) and overall survival (OS, p = 0.022), but not distant metastasis-free survival (DMFS). Multivariate analysis confirmed an impaired outcome in patients with high CAR (LPFS: HR 3.562, 95% CI 1.294–9.802, p = 0.011). CAR is an easily available and independent prognostic marker after CRT in locally advanced NSCLC. CAR may be a useful biomarker for patient stratification to individualize treatment concepts.

The Novel Predictive Biomarkers for Type 2 Diabetes Mellitus in Active Pulmonary Tuberculosis Patients

“…And CAR is an easily available and independent prognostic marker in locally advanced Non-Small Cell Lung Cancer after CRT. 36 It is worth noting that these parameters are being reported for the first time on T2DM in patients with APTB.…”

“…Non-Small Cell Lung Cancer after CRT. 36 It is worth noting that these parameters are being reported for the first time on T2DM in patients with APTB.…”

“…Recently, monocyte to high-density lipoprotein cholesterol ratio (MHR), neutrophils to high-density lipoprotein cholesterol ratio (NHR), C-reactive protein-to-lymphocyte ratio (CLR), and C-reactive protein-to-albumin ratio (CAR) have attracted extensive attention. Elevated MHR, 12,28,29 NHR, [30][31][32] CLR, [33][34][35] and CAR [36][37][38] have been proved to be related to numerous disorders. However, to date, there is no literature on an association between MHR, NHR, CLR and CAR, and APTB-T2DM patients.…”

Establishment of Nomogram Model for Minimally Invasive Treatment of Small Hepatocellular Carcinoma Based on CD8+T Cell Counts

“…It has been successfully used as a prognostic factor for several malignant tumors. 37 , 38 In the field of HCC, studies have also shown that AFP combined with CRP can be used to predict the prognosis of HCC. 39 More importantly, Overexpressed CRP has more significant prognostic significance for patients with AFP negative.…”

Prognostic value of preoperative modified Glasgow prognostic score in surgical non-small cell lung cancer: A meta-analysis

“…Lots of evidence has proven that the systemic inflammation and nutritional status are significantly associated with the incidence, disease progression, therapy and prognosis of cancer patients (5)(6)(7)(8)(9). In the last 10 years, some indexes reflecting the systemic inflammation and nutritional status of the body based on peripheral blood indicators were described and reported to be related to the prognosis of NSCLC patients such as the Creactive protein to albumin ratio (CAR) (10), albumin to globulin ratio (AGR) (11), and systemic inflammation response index (SII) (12). However, all these indexes are continuous variables and it is hard to define the normal or abnormal levels of individual patients.…”