The C‐reactive Protein to Albumin Ratio Predicts Long‐Term Outcomes in Patients with Pancreatic Cancer After Pancreatic Resection

Haruki, Koichiro; Shiba, Hiroaki; Shirai, Yoshio; Horiuchi, Takashi; Iwase, Ryota; Fujiwara, Yuki; Furukawa, Kenei; Misawa, Takeyuki; Yanaga, Katsuhiko

doi:10.1007/s00268-016-3491-4

Cited by 120 publications

(118 citation statements)

References 35 publications

Supporting

Mentioning

116

Contrasting

Unclassified

Order By: Relevance

“…The CRP/Alb ratio is a useful prognostic indicator that was initially used to identify patients with serious conditions on an acute medical ward by Fairclough et al (41). Subsequently, multiple studies have demonstrated that the CRP/Alb ratio exhibited prognostic value in numerous types of cancer (15)(16)(17)(18)42). The present study revealed that a high CRP/Alb ratio indicated increased tumor invasion and metastasis and poorer prognosis compared with a low CRP/Alb ratio.…”

Section: Discussionmentioning

confidence: 52%

“…In a previous study, Alb was used to estimate nutritional status. For patients with GC, protein digestion and absorption were decreased, whereas protein metabolism was increased, resulting in a negative nitrogen balance (18,39). The CRP/Alb ratio is a useful prognostic indicator that was initially used to identify patients with serious conditions on an acute medical ward by Fairclough et al (41).…”

Section: Discussionmentioning

confidence: 99%

“…The C-reactive protein (CRP)/albumin (Alb) ratio is used as a novel inflammation-based prognostic indicator in multiple types of tumor. Previous studies have demonstrated the prognostic value of CRP/Alb ratio in colorectal (14) and esophageal cancer (15), hepatocellular carcinoma (16), and renal (17) and pancreatic cancer (18). Another important inflammatory marker is the neutrophil/lymphocyte ratio (NLR).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

C‑reactive protein/albumin and neutrophil/lymphocyte ratios and their combination predict overall survival in patients with gastric cancer

et al. 2017

View full text Add to dashboard Cite

Abstract. Multiple studies have reported the prognostic association of certain inflammatory factors with various types of cancer. The present study assessed the prognostic value of the C-reactive protein (CRP)/albumin (Alb) ratio and the neutrophil/lymphocyte ratio (NLR), separately and in combination, in gastric cancer (GC). A total of 337 cases pathologically diagnosed with gastric adenocarcinoma were retrospectively evaluated. The clinicopathological and prognostic relevance of the CRP/Alb ratio and NLR and their combination were analyzed. The optimal cut-off values of the CRP/Alb ratio and NLR were 0.38 and 3.14, respectively. High CRP/Alb ratio (≥0.38) and NLR (≥3.14) values were associated with increased tumor invasion, more distant metastasis and a more advanced tumor-node-metastasis stage (all P<0.05). In addition, a high NLR value was also associated with increased tumor size (P= 0.02). The CRP/Alb ratio (≥0.38/<0.38) and NLR (≥3.14/<3.14) were independent prognostic factors for overall survival time (OS) in GC by multivariate analysis (P= 0.005 and P= 0.001). Using the CRP/Alb ratio and NLR classification, patients were stratified into three subgroups with different OS time (P<0.001), which were identified as independent prognostic variables in multivariate analysis (P<0.001). The present study demonstrated that the CRP/Alb ratio and NLR were independent prognostic factors for OS in patients with GC. The combination of these indexes was associated with significant prognostic value and may further stratify prognosis. IntroductionGastric cancer (GC) is one of the most common types of tumor globally. In 2015, GC had the second highest incidence and rate of mortality among cancer patients in China (1). Due to the rapid progression of GC and the absence of early specific symptoms and signs, the majority of patients are diagnosed at the late stage of gastric carcinoma (2-5). At present, surgery is the preferred treatment for patients without distant metastasis, and postoperative metastasis and recurrence are the predominant causes of mortality (3,5). Although disease-free and overall survival (OS) may be improved by postoperative chemotherapy and radiotherapy, the prognosis of GC remains poor (3,6). Identifying simple but effective prognostic markers for GC remains an important aim for researchers.Inflammation occurs in various types of tumor, and serves a crucial function in tumor development and distant metastasis (7-10). Previous studies have indicated that inflammation is associated with the formation of the tumor microenvironment by inflammatory mediators, including vasoactive amines and cytokines (11-13). The C-reactive protein (CRP)/albumin (Alb) ratio is used as a novel inflammation-based prognostic indicator in multiple types of tumor. Previous studies have demonstrated the prognostic value of CRP/Alb ratio in colorectal (14) and esophageal cancer (15), hepatocellular carcinoma (16), and renal (17) and pancreatic cancer (18). Another important inflammatory marker is the neutrophil/lymphocyte ratio (...

show abstract

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

C‑reactive protein/albumin and neutrophil/lymphocyte ratios and their combination predict overall survival in patients with gastric cancer

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Among these, CAR is novel. Haruki et al [19] suggested that for pancreatic cancer patients after pancreatic resection, CAR could be an independent and significant indicator of poor long-term outcome. Shibutani et al [21] found preoperative CAR to be a useful prognostic marker in patients with colorectal cancer undergoing potentially curative surgery.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of the postoperative ratio of C-reactive protein to albumin for complications after colorectal surgery

Cao

Wang

et al. 2017

World J Surg Onc

View full text Add to dashboard Cite

BackgroundThe ratio of C-reactive protein to albumin, as a novel inflammation-based prognostic score, is associated with outcomes in cancer and septic patients. The diagnostic accuracy of the CRP/albumin ratio has not been assessed in colorectal surgery for postoperative complications.MethodsA total of 359 patients undergoing major colorectal surgery between 2012 and 2015 were eligible for this study. Uni- and multivariate analyses were performed to identify risk factors for postoperative complications. Receiver operating characteristic curves were developed to examine the cutoff values and diagnostic accuracy of the CRP/albumin ratio and postoperative CRP levels.ResultsAmong all the patients, 139 (38.7%) were reported to have postoperative complications. The CRP/albumin ratio was an independent risk factor for complications (OR 4.413; 95% CI 2.463–7.906; P < 0.001), and the cutoff value was 2.2, which had a higher area under the curve compared to CRP on postoperative day 3 (AUC 0.779 vs 0.756). The CRP/albumin ratio also had a higher positive predictive value than CRP levels on postoperative day 3. Patients with CRP/albumin ≥2.2 suffered more postoperative complications (60.8% vs 18.6%, P < 0.001), longer postoperative stays (10 (4–71) vs 7 (3–78) days, P < 0.001), and increased surgical site infections (SSIs) (21.1% vs 4.8%, P < 0.001) than those with CRP/albumin <2.2.ConclusionsThe ratio of C-reactive protein to albumin could help to identify patients who have a high probability of postoperative complications, and the ratio has higher diagnostic accuracy than C-reactive protein alone for postoperative complications in colorectal surgery.

show abstract

“…The CRP/ALB ratio was originally developed by Fairclough et al to predict the patient outcome 14. The CRP/ALB ratio has been identified as an independent prognostic factor in several malignancies, including hepatocellular carcinoma 11, esophageal cancer 12, pancreatic cancer 18 and small cell lung cancer 19. Furthermore, Ranzani et al revealed the CRP/ALB ratio was more accurate than CRP level alone for predicting mortality in patients with sepsis 14.…”

Section: Discussionmentioning

confidence: 99%

The C-reactive Protein/Albumin Ratio Is an independent Prognostic Factor for Overall Survival in Patients with Nasopharyngeal Carcinoma Receiving Intensity-Modulated Radiotherapy

Tao¹,

Chen²,

Jiang³

et al. 2016

J. Cancer

View full text Add to dashboard Cite

This study aims to investigate the prognostic value of the C-reactive protein/albumin (CRP/ALB) ratio in nasopharyngeal carcinoma (NPC) in the intensity-modulated radiotherapy (IMRT) era. A total of 719 patients with NPC treated between January 2007 and December 2012 were retrospectively reviewed. Serum albumin and CRP levels were measured before treatment. The associations between the CRP/ALB ratio and clinicopathological parameters were analyzed. Multivariate analyses using the Cox proportional hazards model were performed to identify significant prognostic factors associated with overall survival (OS). The prognostic value of the CRP/ALB ratio was determined using receiver operating characteristic (ROC) curve analysis. The optimal CRP/ALB ratio cutoff value was 0.141. High CRP/ALB ratio was significantly associated with older age (P < 0.001), more advanced T category (P < 0.001) and advanced TNM stage (P = 0.024). Patients with an elevated CRP/ALB ratio (≥ 0.141) had poorer OS than those with a CRP/ALB ratio < 0.141 (5-year OS rates: 91.9% vs. 78.1%; P < 0.001). Multivariate analysis suggested clinical T category [hazard ratio (HR) 2.284; 95% confidence interval (CI), 1.429-3.652; P = 0.001]; clinical N category (HR 1.575; 95% CI, 1.007-2.464; P = 0.047) and CRP/ALB ratio (HR 2.173; 95% CI, 1.128-3.059; P = 0.015) were independently associated with OS. In conclusion, pretreatment CRP/ALB ratio is an objective biomarker with significant prognostic value for OS in NPC. The CRP/ALB ratio can enhance conventional TNM staging to stratify patients and may help facilitate individualized treatment of high-risk cases.

show abstract

The C‐reactive Protein to Albumin Ratio Predicts Long‐Term Outcomes in Patients with Pancreatic Cancer After Pancreatic Resection

Abstract: The CRP/Alb ratio may be an independent and significant indicator of poor long-term outcomes in patients with pancreatic cancer after pancreatic resection.

Cited by 120 publications

References 35 publications

C‑reactive protein/albumin and neutrophil/lymphocyte ratios and their combination predict overall survival in patients with gastric cancer

C‑reactive protein/albumin and neutrophil/lymphocyte ratios and their combination predict overall survival in patients with gastric cancer

Diagnostic accuracy of the postoperative ratio of C-reactive protein to albumin for complications after colorectal surgery

The C-reactive Protein/Albumin Ratio Is an independent Prognostic Factor for Overall Survival in Patients with Nasopharyngeal Carcinoma Receiving Intensity-Modulated Radiotherapy

Contact Info

Product

Resources

About