Prognostic Role of the C-Reactive Protein/Albumin Ratio in Patients With Gynecological Cancers: A Meta-Analysis

Abstract

BackgroundMany studies have investigated the prognostic role of the C-reactive protein/albumin ratio (CRP/Alb ratio) in patients with gynecological cancers; however, there is lack of consensus owing to conflicting results across studies. We performed a meta-analysis to determine the prognostic role of the CRP/Alb ratio in gynecological cancers.MethodsWe searched the PubMed, Embase, the Web of Science, Cochrane Library, China National Knowledge Infrastructure, and Wanfang electronic databases since inception to April 2021. Combined hazard ratios (HRs) and 95% confidence intervals (CIs) were used to estimate the prognostic effect of the CRP/Alb ratio in gynecological cancers. Pooled odds ratios (ORs) and 95% CIs were used to investigate the association between the CRP/Alb ratio and clinicopathological features.ResultsThe meta-analysis included seven studies with 1,847 patients. The pooled results showed that a high pretreatment CRP/Alb ratio was associated with poor overall survival (HR, 1.84; 95% CI, 1.41–2.40; p < 0.001) and progression-/disease-free survival (HR, 2.58; 95% CI, 1.42–4.68; p = 0.002). Additionally, a high CRP/Alb ratio was significantly associated with stages III–IV disease (the International Federation of Gynecology and Obstetrics classification) (OR, 2.98; 95% CI, 1.45–6.14; p = 0.003). However, we observed a non-significant correlation between the CRP/Alb ratio and lymph node metastasis, tumor size, and histopathological grade.ConclusionsThe CRP/Alb ratio is a convenient and accurate predictor of survival outcomes in gynecological cancers. A high CRP/Alb ratio also predicts tumor progression.

Predictive value of post‐treatment C‐reactive protein‐to‐albumin ratio in locally advanced non–small cell lung cancer patients receiving durvalumab after chemoradiotherapy

“…CAR was originally proposed as a prognostic tool in patients with acute sepsis 19 . The use of CAR has recently been reported in various cancers 29–32 . CRP and Alb, which are both acute‐phase proteins, exhibit conflicting kinetics under inflammatory conditions.…”

“…CRP and Alb, which are both acute‐phase proteins, exhibit conflicting kinetics under inflammatory conditions. CRP production in the liver is upregulated by inflammatory cytokines, such as interleukin (IL)‐1, IL‐6, and tumor necrosis factor‐α, and Alb is downregulated under inflammatory conditions 31 . Therefore, CAR can better reflect the altered inflammatory dynamics in the tumor microenvironment.…”

“…19 The use of CAR has recently been reported in various cancers. [29][30][31][32] CRP and Alb, which are both acute-phase proteins, exhibit conflicting kinetics under inflammatory conditions. CRP production in the liver is upregulated by inflammatory cytokines, such as interleukin (IL)-1, IL-6, and tumor necrosis factor-α, and Alb is downregulated under inflammatory conditions.…”

Prognostic Role of Pretreatment C-Reactive Protein to Albumin Ratio in Urological Cancers: A Systematic Review and Meta-Analysis

“…There was increasing evidence of a link between tumor-caused inflammatory response and tumorigenesis and disease progression ( 5 ). Kinds of inflammatory and immune response factors have been reported as survival biomarkers for various cancers ( 6 ). Many other inflammatory biomarkers that were also prognostic in urologic tumors, such as neutrophil-to-lymphocyte ratio (NLR) ( 34 ), platelet-to-lymphocyte ratio (PLR) ( 35 ), lymphocyte-to-monocyte ratio (LMR) ( 36 ), etc.…”

“…There was increasing evidence of a link between tumor-caused inflammatory response and tumorigenesis and disease progression ( 5 ). Kinds of inflammatory and immune response factors have been reported as survival biomarkers for various cancers ( 6 ). The C-reactive protein to albumin ratio (CAR) is a measure of serum C-reactive protein (CRP) and albumin and is generated as the CRP level divided by the albumin level.…”