Clinical impact of C-reactive protein to albumin ratio of the 7th postoperative day on prognosis after laparoscopic colorectal cancer surgery

Abstract

Purpose: C-reactive protein to albumin ratio (CAR) has been utilized as a prognostic factor in various carcinomas. We investigated the relationship between preoperative, postoperative day (POD) 1, and POD 7 CARs and the prognosis of patients with colorectal cancer (CRC).Methods: Three hundred twenty patients with CRC who underwent laparoscopic radical resection between May 2011 and December 2016 were enrolled. Patients were selected into 2 groups, high CAR and low CAR (n=72/group), based on preoperative, POD 1, and POD 7 CARs. The relapse-free survival (RFS) and overall survival (OS) were compared between groups using propensity score matching.Results: The high CAR group had a significantly worse RFS (P<0.001) and OS (P=0.002) at POD 7 than those in the low CAR group. However, in preoperative and POD 1 analysis, no differences were observed.Conclusion: In patients with CRC, CAR of POD 7 was a significant prognostic factor.

Applications of propensity score matching: a case series of articles published in Annals of Coloproctology

“…In the study by Kataoka et al [ 6 ], the participants were divided into 2 according to the C-reactive protein to albumin ratio (CAR) in a preoperative examination and at postoperative days 1 and 7 using cut-off values of CAR determined by analyzing the receiver operating characteristic curves for the survival rate. However, the CAR has been reported to be associated with colorectal cancer prognosis [ 12 , 13 ].…”

“…However, the criterion for defining each comparison group was invasion depth, which is not a parameter that we can modify at will. As in the abovementioned study by Kataoka et al [ 6 ], this would involve “comparing apples and oranges.” It would rather be better to compare outcomes according to whether patients underwent laparoscopy in each stratum (LARC or NLARC), and the efficacy of laparoscopy in patients with NLARC should be determined according to differences in the quality of surgical specimens, morbidity, and mortality.…”

“…Propensity scores were estimated by Kataoka et al [ 6 ] based on a logistic regression model addressing the following 11 variables: age as a continuous variable, sex, American Society of Anesthesiologists physical status classification, serum CEA level, serum carbohydrate antigen 19-9 (CA19-9) level, tumor location, tumor size, tumor histotype, lymphatic invasion, venous invasion, and TNM stage as categorical variables. While the variable selection for propensity score estimation seems to be appropriate, the propensity score could be different if the serum CEA level or CA19-9 level is included as a continuous variable in the model.…”

“…This article was conducted to review the process of PSM conducted in original articles published in Annals of Coloproctology . There were 5 articles using PSM, as described in Table 1 [ 6 - 10 ], and each was reviewed for issues related to comparability between the comparison groups and the appropriateness of applying PSM.…”

Prognostic prediction of colorectal cancer using the C-reactive protein to albumin ratio: the importance of inflammatory biomarkers and their association with long-term outcomes

“…Kataoka et al [ 8 ] found a distinct association between CAR on postoperative day (POD) 7 and prognosis. They proposed that CAR on POD 7 plays a significant role in the metastatic process of cancer.…”