C-reactive protein : albumin ratio in patients with resectable intrahepatic cholangiocarcinoma

Abstract

Background: The C-reactive protein : albumin ratio (CAR) has been reported as a novel prognostic marker in several cancers. The aim of this study was to investigate the prognostic value of CAR in patients with intrahepatic cholangiocarcinoma (ICC). Methods: This was a single-centre retrospective study of patients who underwent surgery for ICC in a university hospital in Japan between 1998 and 2018. CAR, Glasgow Prognostic Score (GPS) and modified GPS (mGPS) were calculated. Their correlation with recurrence-free survival (RFS) and overall survival (OS) was analysed with Cox proportional hazards models. Results: Seventy-two patients were included in the study. Patients were divided into two groups according to the optimal CAR cutoff value of 0⋅02. CAR above 0⋅02 was associated with higher carbohydrate antigen 19-9 levels (20⋅5 versus 66⋅1 units/ml for CAR of 0⋅02 or less; P = 0⋅002), larger tumour size (3⋅2 versus 4⋅4 cm respectively; P = 0⋅031) and a higher rate of microvascular invasion (9 of 28 versus 25 of 44; P = 0⋅041). RFS and OS were shorter in patients with CAR above 0⋅02: hazard ratio (HR) 4⋅31 (95 per cent c.i. 2⋅02 to 10⋅63) and HR 4⋅80 (1⋅85 to 16⋅40) respectively. In multivariable analysis CAR above 0⋅02 was an independent prognostic factor of RFS (HR 3⋅29 (1⋅33 to 8⋅12); P < 0⋅001), but not OS. Conclusions: CAR was associated with prognosis in patients who had hepatic resection for ICC.

An Inflammation-Index Signature Predicts Prognosis of Patients with Intrahepatic Cholangiocarcinoma After Curative Resection

“…34 Several studies for predicting survival of ICC patients after surgery had been reported before. 36,37 Compared with these studies, our study has several advantages. Firstly, as a study based on multiple cohorts, the number of included patients in this study was larger than those of other studies.…”

Clinical value and limitations of the preoperative C‐reactive‐protein‐to‐albumin ratio in predicting post‐operative morbidity and mortality after deceased‐donor liver transplantation: a retrospective single‐centre study

“…Since Fairclough et al. [43] first proposed CAR as a prognostic marker to identify acutely sick patients, multiple studies have demonstrated its predictive value regarding morbidity and mortality in critically ill patients [19,20,22,29], in cirrhotic patients awaiting liver transplantation [23,24], as well as in patients undergoing colorectal [21,30], pancreatic [25], gastro‐oesophageal [44,45] and liver [26,46] surgery. In oncological patients, an association has been shown between high CAR and lower overall‐ [44,47,48] and disease‐free survival rates [26,29], as well as advanced tumour stage [25,26,47,48].…”

“…Moreover, an intrinsic limitation of CAR is its lack of specificity, as CRP and Alb levels are affected by a multitude of factors, as previously mentioned. Both CRP and Alb are synthesized in the liver [26,28,46,48], which explains their inclusion in clinical scores such as SOFT [7] and Child‐Pugh [54], which are used to stratify risk of adverse outcomes in patients with liver disease. Although the exact relationship between serum levels of CRP / Alb and liver dysfunction is a matter of dispute [20,28], it stands to reason, that patients with liver dysfunction may exhibit more distorted preoperative CAR, making comparisons with other patient cohorts undergoing surgery difficult.…”

“…Furthermore, where some studies carry out an ROC analysis to determine the optimal cut‐off, others use arbitrary cut‐offs or different statistical methods to define cohort‐specific cut‐off values. Nevertheless, multiple studies (including this one ‐ see Supplement I) have shown that CAR is more accurate in predicting morbidity and mortality in multiple scenarios, compared to CRP or Alb alone [20,21,25,26,28,44–46] or other inflammation scores [28,29,47]. Although this may justify the utilization of CAR, validation and standardization would go a long way to increase its usefulness and clinical applicability.…”

A New Prognostic Model Covering All Stages of Intrahepatic Cholangiocarcinoma

“…FIB, carbohydrate antigen 125 (CA125), LDH and iron. ALB has been used frequently as a prognostic indicator of ICC, for its relation with liver reserve function and nutritional status 22,23. FIB was also reported as a prognostic factor of CCA 24.…”