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

Abstract

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 (...

Clinical significance and prognostic value of C-reactive protein/albumin ratio in gastric cancer

“…We also found that CAR has a higher prognostic value in predicting the 1-, 3-, 5-year survival of patients. However, inconsistent with previous studies [12,14,20] , we failed to showed that CAR was associated with clinical features of gastric cancer, and the discriminated value for the early and advanced TNM stage was moderated, suggesting that the prognostic value of CAR might independent of the clinical features of gastric cancer.…”

“…Evidences showed that CAR was an important inflammation-based prognostic indicator that associated with various cancer survival outcomes [22,23] . In the present study, we found that CAR was an independent prognostic indicator in patients with gastric cancer, which was in agreement with previous studies [12,13,20] . We also found that CAR has a higher prognostic value in predicting the 1-, 3-, 5-year survival of patients.…”

“…Liu et al [18] also observed that CAR was associated with the lymphnode metastasis and clinical stage of gastric cancer. The similar result was found in Mao et al [12] report. However, in the present study, we failed to show the association with the clinical features, including the TNM stage, which was similar to the Saito et al [13] report, indicating that the change of CAR might be independent of the TNM stage.…”

“…Seven studies [12][13][14][17][18][19][20] with 1978 patients that evaluated the prognostic value of CAR in patients with gastric cancer were included the meta-analysis. The details of included studies were listed in Table 4.…”

“…CAR is a novel inflammation-based prognostic indicators, high expression of CAR was associated with poor outcome in various diseases, including sepsis [9] , pancreatitis [10] , and various cancers [11] . The prognostic value of CAR in patients with gastric cancer has also been explored [12][13][14] . However, the robustness of previous studies still needed to validate by more studies.…”