Prognostic Implication of Preoperative Serum Albumin to Carcinoembryonic Antigen Ratio in Colorectal Cancer Patients

Abstract

Both preoperative serum albumin (ALB) and carcinoembryonic antigen (CEA) were previously reported as useful prognostic factors in colorectal cancer (CRC); however, the ALB to CEA ratio (ACR) and their individual prognostic efficacies have been less studied. In this study, a total of 156 CRC patients staged I-IV were retrospectively enrolled. Patients were divided into ACR-low or ACR-high subgroups, and the differences in progression-free survival (PFS) and overall survival (OS) were conducted by Kaplan-Meier curves, log-rank test and Cox proportional model. As a result, a total of 31.41% (49/156) of patients presented with ACR-low disease, and these patients had tumors with advanced T stages (T3 + T4) (P<0.01), larger tumor diameters (P<0.01) and distant metastases (P = 0.01) and a relatively lower lymphocyte to monocyte ratio (LMR) (P<0.01). The ACR was significant in predicting survival. When 5.98 was used as the cutoff point, it had a sensitivity of 58.50% and 61.50% and a specificity of 83.50% and 80.50% for PFS and OS, respectively. ACR displayed a superior prognostic efficacy than other tested markers for both PFS and OS (except LMR). Patients in the ACR-low group displayed significantly worse PFS (log rank = 35.75, P<0.01) and OS (log rank = 29.68, P<0.01) than those in the ACR-high group. Finally, ACR was an independent prognostic factor for both PFS (HR = 0.31, 95% CI: 0.17–0.56, P < 0.01) and OS (HR = 0.33, 95% CI: 0.16–0.66, P < 0.01). For conclusion, the ACR was a robust prognostic factor in CRC, and patients with a relatively low preoperative ACR had significantly worse survival.