A novel inflammation-based prognostic score in esophageal squamous cell carcinoma: the C-reactive protein/albumin ratio

Abstract

BackgroundPlenty of studies have demonstrated the prognostic value of various inflammation-based indexes in cancer. This study was designed to investigate the prognostic value of the C-reactive protein/albumin (CRP/Alb) ratio in esophageal squamous cell carcinoma.MethodsA retrospective study of 423 cases with newly diagnosed esophageal squamous cell carcinoma was conducted. We analyzed the association of the CRP/Alb ratio with clinicopathologic characteristics. The prognostic value was explored by univariate and multivariate survival analysis. In addition, we compared the discriminatory ability of the CRP/Alb ratio with other inflammation-based prognostic scores by evaluating the area under the receiver operating characteristics curves (AUC), including the modified Glasgow Prognostic Score (mGPS), neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR).ResultsThe optimal cut-off value was identified to be 0.095 for the CRP/Alb ratio. A higher level of the CRP/Alb ratio was associated with larger tumor size (P < 0.001), poorer differentiation (P = 0.019), deeper tumor invasion (P = 0.003), more lymph node metastasis (P = 0.015), more distant metastasis (P < 0.001) and later TNM stage (P < 0.001). The CRP/Alb ratio was identified to be the only inflammation-based prognostic score with independent association with overall survival by multivariate analysis (P = 0.031). The AUC value of the CRP/Alb ratio was higher compared with the NLR and PLR, but not mGPS at 6, 12 and 24 months of follow-up. In addition, the CRP/Alb ratio could identify a group of patients with mGPS score of 0 who had comparable overall survival with those with mGPS score of 1.ConclusionsThe CRP/Alb ratio is a novel but promising inflammation-based prognostic score in esophageal squamous cell carcinoma. It is a valuable coadjutant for the mGPS to further identify patients’ survival differences.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1379-6) contains supplementary material, which is available to authorized users.

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

“…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.…”

“…Therefore, different statistical methods may obtain different thresholds. However, the method used by the present study was based on R, which has been reliably used by other studies (15,51,52). To conclude, the present study revealed that the combination of the CRP/Alb ratio and NLR represents a potential inflammation-based prognostic marker.…”

“…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).…”

C-reactive protein/albumin ratio as prognostic score in oral squamous cell carcinoma

“…Analogous results were reported by Zhou et al16 in patients with small-cell lung cancer and by Xu et al41 in esophageal cancer. The optimal cut-off value for CRP/alb ratio of hepatocellular carcinoma, small-cell lung cancer, esophageal squamous cell carcinoma and OSCC is 0.037, 0.441, 0.0951516171841, and 0.085, respectively. There are various cut-off values according to the kind of cancer.…”

“…CRP is an acute phase response protein, and an increase in CRP is related to a worsening inflammatory status and progression of the cancer13, whereas a decrease in alb level is related to a chronic inflammatory state and poor nutritional status14. Recently, a new inflammation-based prognostic score, the CRP/alb ratio, was introduced and is reportedly comparable or superior to other inflammation-based prognostic scores in predicting prognosis in malignant tumors such as those of the liver and lung15161718. However, whether or not the CRP/alb ratio correlates with prognosis in patients with oral squamous cell carcinoma (OSCC) has yet to be determined.…”