The Clinical Influence of the C-Reactive Protein-to-Albumin Ratio in Patients Who Received Curative Treatment for Gastric Cancer

Abstract

Background: We investigated the impact of the pre-surgical C-reactive protein-to-albumin ratio (CAR) on survival and recurrence after curative treatment for gastric cancer. Patients and Methods: This study included 481 patients who underwent curative treatment for gastric cancer between 2013 and 2017. The risk factors for overall (OS) and recurrence-free (RFS) survival were identified. Results: A CAR of 0.05 was regarded as the optimal critical point of classification considering the 3-and 5-year survival rates and patients were divided according to their CAR. The OS rates at 3 and 5 years after surgery were significantly higher at 92.5% and 87.9%, respectively, in the low-CAR group compared with 84.9% and 71.9%, respectively, in the high-CAR group. The corresponding RFS rates were 89.1% and 85.5%, and 81.0% and 72.2%, respectively, also a significant difference. A multivariate analysis demonstrated that the CAR was a significant independent risk factor for the OS and marginally significant independent risk factor for the RFS. In addition, the incidences of pancreatic fistula and abdominal abscess were significantly higher and the rate of introduction of adjuvant chemotherapy significantly lower in the high-CAR group. Conclusion: The CAR was a risk factor influencing survival in patients who underwent curative treatment for gastric cancer. An effective perioperative care plan and surgical strategy need to be developed according to the CAR.

C‐reactive protein to albumin ratio (CAR) in predicting surgical site infection (SSI) following instrumented posterior lumbar interbody fusion (PLIF)

“…CAR, as a novel index, has proved to provide useful prognostic information for sepsis, abdominal surgeries, cancer, or emergency laparotomy 10‐13,30 . However, the cut‐off selected for use are often inconsistent, even quite different.…”

“…CAR, as a novel index, has proved to provide useful prognostic information for sepsis, abdominal surgeries, cancer, or emergency laparotomy. 10 , 11 , 12 , 13 , 30 However, the cut‐off selected for use are often inconsistent, even quite different. For example, Hu et al 31 used 0.24 as cut‐off value to predict the overall survival in patients with osteosarcoma and Shi et al used 0.27 to predict periprosthetic joint infection, both of which were 3‐fold as ours (0.09); while in a study of gastric cancer, Aoyama et al 12 found the optimal cut‐off point of CAR was 0.05 to optimally evaluate the overall survival and recurrence‐free survival.…”

“… 10 , 11 , 12 , 13 , 30 However, the cut‐off selected for use are often inconsistent, even quite different. For example, Hu et al 31 used 0.24 as cut‐off value to predict the overall survival in patients with osteosarcoma and Shi et al used 0.27 to predict periprosthetic joint infection, both of which were 3‐fold as ours (0.09); while in a study of gastric cancer, Aoyama et al 12 found the optimal cut‐off point of CAR was 0.05 to optimally evaluate the overall survival and recurrence‐free survival. Specific at SSI following a range of surgeries, but not including spinal surgeries, the findings were not conclusive, 18 , 32 , 33 and some researchers suggested the postoperative early‐period (day 1 or 2) rather than preoperative CAR should be more applicable.…”

“…Inflammation‐based prognostic factors have attracted increasing attention in multiple settings, largely because they combine the systemic inflammatory status and pathological burden. C‐reactive protein to albumin ratio (CAR) has demonstrated its effectiveness in predicting clinical outcomes or adverse events in a range of conditions, for example, cancers of liver, 9 lung, 10 pancreas 11 and intestines/stomach, 12 , 13 severe burn injury, 14 or musculoskeletal disorders. 15 , 16 , 17 Specified at postoperative infection, Goulart et al 18 identified CAR on postoperative day 3 as an independent predictor after colorectal cancer surgery.…”

Prognostic significance of preoperative C-reactive protein to albumin ratio in non-small cell lung cancer patients: A meta-analysis

“…C-reactive protein (CRP) and albumin can represent the inflammatory response and nutritional status in a better way, and studies have confirmed that high CRP and low albumin levels are significantly correlated with the poor prognosis of patients with lung cancer (10,11). CRP to albumin ratio (CAR) has been confirmed as an independent prognostic factor in patients with gastric, esophageal, or pancreatic cancers (12)(13)(14). Some previous studies have explored the relationship between CAR and the clinical characteristics and prognosis in lung cancer.…”