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

Abstract

Background/Aim: C-reactive protein to albumin ratio (CAR) has been utilized as a prognostic factor in various carcinomas. We investigated the relationship between preoperative, first postoperative day (POD1), and seventh postoperative day (POD7) CARs and the prognosis of patients with colorectal cancer (CRC). Patients and Methods: 320 patients with CRC who underwent laparoscopic radical resection between May 2011 and December 2016 were enrolled. Patients were selected into two groups, high CAR and low CAR, based on preoperative, POD1, and POD7 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 and OS (n=72/group, RFS: p<0.001; OS: p=0.002) at POD7 than those in the low CAR group. However, in preoperative and POD1 analysis, no differences were observed. Conclusion In patients with colorectal cancer, CAR of POD7 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][7][8][9][10], and each was reviewed for issues related to comparability between the comparison groups and the appropriateness of applying PSM.…”

Multi-gene models for survival prognosis of colorectal cancer patients

“…Treatment for CRC includes surgery, chemotherapy, targeted therapy and combination therapy [9,10] . Stage I and II CRC are usually treated with surgery combined with chemotherapy, while stage III and IV are more often treated with targeted therapy and combination therapy [11] . Clinical tumour markers for CRC are carcinoembryonic antigen carcinoembryonic antigen(CEA), Carbohydrate antigen19-9 CA19-9 , Alpha-fetoprotein AFP , Cancer antigen 125 CA-125 , etc [8,12,13] .…”