Clinical and prognostic implications of pretreatment albumin to C-reactive protein ratio in patients with hepatocellular carcinoma

Abstract

Background Despite recent advances in the treatments of hepatocellular carcinoma (HCC), the prognosis of HCC patients remains controversial. The purpose of this study was to investigate the prognostic performance of pretreatment albumin to C-reactive protein ratio (ACR) in patients with HCC. Methods This study included 409 initially diagnosed HCC patients retrospectively. The optimal cut-off points for distinguishing high and low ACR value was determined by the X-tile software. The chi-squared test was used for comparing the baseline clinicopathologic parameters in different groups and subgroups. The Cox regression with log-rank tests was used to analyze OS and DFS, and Kaplan-Meier curves was used to estimate the prognosis of HCC patients. Results Patients with lower ACR were significantly correlated with advanced clinical parameters, using a cut-off points of 5.4 (high ACR, n = 236 vs. low ACR, n = 173). Multivariate analysis demonstrated that ACR was associated with OS (HR = 0.544, 95% CI: 0.385–0.769, p = 0.001), with DFS (HR = 0.550, 95% CI: 0.392–0.772, p = 0.001). Treatment exposure (HR = 2.191; 95% CI: 1.533–3.132; p < 0.001), tumor size (HR = 1.973; 95% CI: 1.230–3.164; p = 0.005), serum AFP level (HR = 1.752; 95% CI: 1.277–2.403; p = 0.001), and TNM stage (HR = 0.470; 95% CI: 0.319–2.504; p < 0.001), were independent factors for OS in HCC patients. Treatment exposure (HR = 2.244; 95% CI: 1.590–3.166; p < 0.001), TNM stage (HR = 2.075; 95% CI: 1.436–3.000; p < 0.001), serum AFP level (HR = 1.819; 95% CI: 1.340–2.469; p = 0.001), tumor size (HR = 1.730; 95% CI: 1.113–2.689; p = 0.015), and ACR (HR = 0.550; 95% CI: 0.392–0.772; p = 0.001) were independent factors for DFS in HCC patients. Conclusions Pretreatment ACR is a convenient and useful parameter for HCC patients predicting OS and DFS. Lower ACR was associated with advanced TNM stage, larger tumor size, and a high concentration of AFP. These results may help to design strategies to personalize management approaches among HCC patients.

High C-reactive protein/albumin ratio associated with reduced survival due to advanced stage of intrahepatic cholangiocarcinoma

“…Given that many ICC patients experience early recurrence even after curative resection, it is possible that patient survival is longer in our Low CRP/Alb group, and in the GPS-Low group in the Pan et al (11) study, due to the possible continuation of cancer treatments for recurrent tumors, including chemotherapy, radiation therapy, transcatheter arterial chemoembolization, and infusion. It has been reported that GPS and CRP/Alb ratio are positively associated with primary liver cancer progression; tumor stage is more advanced in patients with a higher GPS (7,11) and CRP/Alb ratio (8,9). Consequently, both overall and recurrence-free survival of patients in these studies were without exception significantly reduced in the high GPS and CRP/Alb ratio groups.…”

“…Both inflammation and nutrition-based prognostic systems such as the Glasgow prognostic score (GPS) and C-reactive protein/Albumin (CRP/Alb) ratio are brief and useful markers for surgical outcomes in patients with diverse forms of gastroenterological cancer, such as esophageal (1), gastric (2), colorectal (3,4), and pancreatic cancer (5,6). In primary liver cancer, high scores of GPS and CRP/Alb ratio have also been associated with reduced survival after operation in patients with hepatocellular carcinoma (7)(8)(9), although it is still unclear whether CRP/Alb ratio can predict survival in patients with intrahepatic cholangiocarcinoma (ICC) (10,11).…”

Clinical Significance of C-Reactive Protein to Albumin Ratio in Patients with Hepatocellular Carcinoma: A Meta-Analysis

“…9 records were excluded for duplication by NoteExpress 3.1, and then, 186 records were excluded after browsing titles and abstracts. Hence, 7 records [ 13 – 19 ] including 202 patients published since 2014 were enrolled into our meta-analysis. The search results and details were shown in Figure 1 .…”

“…Recently, high CAR has been reported to be correlated with poor prognosis of patients with HCC [ 13 – 19 ], but the results varied from each other. And to the best of our knowledge, there are no meta-analysis and systematic review evaluating the prognostic value of CAR in patients with HCC.…”

The Value of C-Reactive Protein, C-Reactive Protein Kinetics and C-reactive Protein to Albumin Ratio on Prognosis in Newly Diagnosed Indolent B-cell Non-Hodgkin Lymphoma

“…In addition, the prognostic value of CRP kinetics, dynamic change of CRP level throughout treatment, has been con rmed in metastatic nasopharyngeal carcinoma and renal cell carcinoma [27][28][29]. Furthermore, a novel prognostic markers involving in ammation and nutrition, CRP to albumin ratio (CAR), has been evaluated in colorectal cancer, liver cell carcinoma, lung cancer, and other solid tumors [30][31][32][33][34]. The prognostic signi cance of CRP level, CRP kinetics and CAR in B-iNHL are unclear.…”