Post-diagnostic C-reactive protein and albumin predict survival in Chinese patients with non-small cell lung cancer: a prospective cohort study

Abstract

Non-small cell lung cancer (NSCLC) is the most commonly diagnosed lung cancer and is associated with poor prognosis. This study aimed to analyze if serum C-reactive protein (CRP), albumin (Alb), and CRP/Alb ratio could provide prognostic information in patients with NSCLC. 387 patients with primary NSCLC were included in this analysis. Cox proportional hazards regression was used to estimate hazard ratio (HR) and 95% confidence interval (CI) of death with adjustment for some potential confounders. The multivariate regression analyses revealed the statistically significant associations of decreased survival of patients with NSCLC with elevated CRP, decreased Alb, and elevated CRP/Alb ratio. The HRs of mortality were 1.56 (95% CI: 0.80–3.04) and 2.64 (95% CI: 1.35–5.16) for patients in the second and the highest tertiles of CRP ( P -trend = 0.003). For albumin, the HR was 0.50 (95% CI: 0.29–0.85) for the normal group. The CRP/Alb ratio strongly predicted the survival of patients in the highest tertile with a fourfold risk of dying compared with those in the lowest tertile (HR = 4.14, 95% CI: 2.15–7.98). The subgroup analysis according to various patient characteristics confirmed these associations. In conclusion, serum CRP, albumin, and CRP/Alb ratio are predictive of survival for Chinese patients with NSCLC.

Clinical implication of serologic indexes and compositional changes of immune cells on hyperprogressive disease in non-small cell lung cancer patients receiving immunotherapy

“…Regardless, there is some debate as to whether in ammation-based serologic markers obtained from systemic circulating blood denote the degree of immune response at the local tumor. Whatever the reason, many research results strongly support the evidence that local immune response manifests adequate prognostic value [21]. These serologic markers, as well as imaging studies, may provide additional information concerning the tumor response to immunotherapy in patients with advanced NSCLC.…”

“…Even though lower PD-L1 expression was signi cantly associated with HPD, these events sometimes occurred even in the patients with high PD-L1 expression. Furthermore, NLR and PLR, hematological indicators re ecting the changes of blood cell pattern, are a secondary local response to immunotherapy [21,22,31]. Hence, with the exception of CAR, serologic markers before immunotherapy have no clinical implication.…”

“…In addition to natural killer (NK) cells and dendritic cells, cancer associated broblasts, which regulate the dynamic process of M2 transformation, can affect the response to cancer immunotherapy [10]. Furthermore, in ammatory reaction indices in the peripheral blood do not directly re ect the local immune responses occurring at tumor; nonetheless, the systemic indices closely connected with the tumor response to immunotherapy [21,22]. Accordingly, we hypothesized that there may be meaningful distinctions in clinical features, serologic markers, and compositional changes of immune cells among patient groups displaying different tumor response to immunotherapy.…”

Increased pretreatment C-reactive protein-to-albumin ratio predicts severe coronavirus disease 2019

“…It has been speculated that CRP may have signi cant proin ammatory effects by binding to ligands exposed on cells or other autologous structures as a result of infection, in ammation, and other pathologies and then triggering complement activation, eventually exacerbating tissue damage and leading to more severe disease. Previous studies reported that the CRP level was an independent factor that was predictive of a poor prognosis in patients with cardiovascular disease, non-small-cell lung cancer and gastric cancer [21][22][23]. A retrospective study by Li et al recently reported that an increase in the CRP level can be used as an indicator of disease progression in patients with COVID-19 [24].…”

Albumin-to-alkaline phosphatase ratio serves as a prognostic indicator in unresectable pancreatic ductal adenocarcinoma: a propensity score matching analysis

“…Moreover, ALB has been found to suppress the cell cycle and progression of hepatocellular carcinoma [31] [32]. Recent lines of evidence have identified ALB as an independent prognostic indicator in various malignant tumors, including lung [33], breast [34], and gastric cancers [35].…”