Endoscopy is the gold standard procedure for the early detection of neoplasia of the digestive system, and biopsy is still required for the accurate assessment of microscopic lesions. The develop− ment of an imaging system would be a major advance in the clin− ical diagnosis of gastrointestinal pathology. Magnifying endosco− py provides images magnified up to 100, which show minute surface structures and microvessels in the gastrointestinal tract [1]. The recent development of a fiberoptic confocal endomicro− scope (Optiscan Imaging Pty Ltd, Melbourne, Victoria, Australia) in the distal tip of a conventional video endoscope (EC−3870K; Pentax Corp., Tokyo, Japan) enables the observation of tissues at the cellular level, with images magnified up to 1000 [2].
Although the neutrophil to lymphocyte ratio (NLR) was reported to be a predictive biomarker for clinical outcomes in various types of cancer, including recurrent or metastatic head and neck cancer (R/M HNSCC) treated with nivolumab, the usefulness of the pretreatment C-reactive protein/albumin ratio (CAR) as a prognostic marker remains to be clarified. This study aimed to analyze the clinical usability of the CAR in comparison with that of the NLR. 46 R/M HNSCC patients treated with nivolumab were retrospectively analyzed. The optimal cutoff value for the CAR was calculated using receiver operating characteristic curve analysis. The optimal cutoff value for the CAR was set to 0.30. On multivariate analyses, a high CAR was significantly associated with poor overall survival (adjusted HR, 2.19; 95% CI, 1.42–3.47; p < 0.01) and progression-free survival (adjusted HR, 1.98; 95% CI, 1.38–2.80; p < 0.01). The overall response rate and disease control rate for the high CAR patients were lower than for the low CAR patients. The CAR had significantly higher area under the curve values than the NLR at 2 and 4 months. The pretreatment CAR might be an independent marker for prognosis and efficacy in R/M HNSCC patients treated with nivolumab.
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