Prognostic value of C‐reactive protein/albumin ratio for patients with hypopharyngeal and laryngeal cancer undergoing invasive surgery involving laryngectomy

Kuboki, Akihito; Kanaya, Hiroaki; Nakayama, Tsuguhisa; Konno, Wataru; Goto, Kazutaka; Nakajima, Itsuo; Kashiwagi, Takashi; Hirabayashi, Hideki; Haruna, Shinichi

doi:10.1002/hed.25565

Cited by 25 publications

(19 citation statements)

References 40 publications

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“…The preoperative nomogram's primary advantage is that it can predict individualized 3-and 5-year survival, thereby helping surgeons to identify patients who are likely to benefit from extensive surgery and multidisciplinary management. Nomograms have been used as prognostic adjuncts for several types of cancer; thus, they play a major role in personalized oncology medicine (Kao et al, 2018;Kattan et al, 1998;Li et al, 2016). In the present study, a high CAR was strongly associated with a more advanced disease stage, lymph node metastasis with ENE, DOI >10 mm, need for adjuvant therapy, and shorter survival.…”

Section: Discussionsupporting

confidence: 52%

“…In the present study, we assumed the CAR cutoff of 0.195 may be useful for predicting OS and DFS in patients with OSCC, and this index may have a cutoff specific for primary tumors at different sites (He et al, 2016;Kuboki et al, 2019;Park, Kim & Kim, 2016;Yu et al, 2017). Among all studies on head neck cancers, Wang et al (2019) reported the highest cutoff CAR value of 0.525 as a prognostic indicator in patients with OSCC; their study, however, included high proportions of patients aged >60 years and with advanced disease stage.…”

Section: Discussionmentioning

confidence: 99%

“…Among all studies on head neck cancers, Wang et al (2019) reported the highest cutoff CAR value of 0.525 as a prognostic indicator in patients with OSCC; their study, however, included high proportions of patients aged >60 years and with advanced disease stage. A recent study on CAR's prognostic value in enrolled patients with advanced hypopharyngeal cancer, two-thirds of whom were aged >65 years, also suggested a relatively high CAR cutoff of 0.32 to be useful for predicting prognosis (Kuboki et al, 2019). Yu et al (2017) found a CAR of 0.047 for predicting the laryngeal cancer prognosis; they enrolled a large proportion of patients with early-stage laryngeal cancer and relatively young population.…”

Section: Discussionmentioning

confidence: 99%

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A retrospective study on the prognostic value of preoperative C-reactive protein to albumin ratio in patients with oral cavity squamous cell carcinoma

Fang

Lai

Hsu

et al. 2020

PeerJ

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Background Although the C-reactive protein-to-albumin ratio (CAR) can predict poor outcomes in assorted cancers, its prognostic value in oral cavity squamous cell carcinoma (OSCC) remains unclear. We explored the value of preoperative CAR in predicting clinical outcomes in OSCC patients treated with radical surgery. Methods All the recommended cutoff values were defined analyzing receiver operating characteristic curves or overall survival (OS). Dichotomization was performed on the basis of optimal CAR cutoff, and we compared the clinicopathological features between groups. Kaplan–Meier analysis was also performed to compare OS curves between the two groups. Univariate and multivariate analyses using the Cox proportional hazards model were conducted to find the clinical characteristics that were most closely correlated with disease free survival (DFS) and overall survival (OS). A nomogram incorporated CAR and several clinicopathological factors was established to predict prognosis and its accuracy was evaluated using concordance index (c-index). Results In this retrospective study, a total of 326 patients with newly diagnosis of OSCC and received primary surgery between 2008 and 2017 were enrolled. Through the executed ROC curve analyses, the optimal CAR cutoff derived was 0.195 (area under the curve = 0.718, p < 0.001), with this cutoff exhibiting a discrimination ability superior to that of other inflammation-based prognostic scores after comparing the area under curves. Multivariate analysis demonstrated that CAR (≥0.195/<0.195) was associated with OS (hazard ratio 3.614; 95% CI [1.629–8.018]; p = 0.002) and DFS (hazard ratio 1.917; 95% CI [1.051–3.863]; p = 0.029). Kaplan–Meier analysis and log rank test revealed a significant difference in DFS and OS curves between patients with low CAR (<0.195) and those with high CAR (≥0.195; both p < 0.001). The c-index of the nomogram based on TNM system alone was 0.684 and could be increased to 0.801 if CAR and other clinicopathological factors were included. Conclusions Preoperative CAR could constitute an independent prognostic indicator for OS and DFS prediction in OSCC patients treated with curative surgery. The established nomogram that incorporated CAR and prognostic factors might increase the accuracy of prognostic prediction for patients with OSCC.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A retrospective study on the prognostic value of preoperative C-reactive protein to albumin ratio in patients with oral cavity squamous cell carcinoma

Fang

Lai

Hsu

et al. 2020

PeerJ

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“…In addition, a Taiwanese group published various studies on the prognostic role of CRP in oral cancer and could consistently demonstrate an association between elevated CRP levels and survival [34][35][36]. More recently, pre-therapeutic indices of systemic inflammation based on CRP and albumin have been found to provide prognostic information in nasopharyngeal and laryngeal cancer patients [37,38].…”

Section: Discussionmentioning

confidence: 99%

The Pre-Treatment C-Reactive Protein Represents a Prognostic Factor in Patients with Oral and Oropharyngeal Cancer Treated with Radiotherapy

Knittelfelder

Delago

Jakse

et al. 2020

Cancers

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The purpose of the present study was to evaluate the prognostic significance of the pretreatment C-reactive protein (CRP) level in a cohort of 503 patients with oral and oropharyngeal cancer treated at a tertiary academic center between 2000 and 2017. Cancer-specific survival (CSS), overall survival (OS) and loco-regional control (LC) were calculated using Kaplan-Meier analysis. To evaluate the prognostic value of the CRP level for the clinical endpoints, univariate and multivariate Cox regression models were applied. The median follow-up period was 61 months. Patients were divided into elevated CRP (≥5 mg/L) and normal CRP groups, according to pre-treatment plasma levels. An increased CRP level was significantly associated with shorter CSS (p < 0.001, log-rank test), as well as with shorter OS (p < 0.001, log-rank test) and loco-regional control (p = 0.001, log-rank test). In addition, multivariate analysis identified CRP as an independent predictor for CSS (hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.08-2.35; p = 0.020) as well as for OS (HR 1.62, 95%CI 1.17-2.24; p = 0.004) and LC (HR 1.50, 95%CI 1.06-2.14; p = 0.023). In subgroup analysis, Kaplan Meier curves revealed that an elevated pre-treatment CRP level was a consistent prognostic factor for poor CSS (p = 0.003, log-rank test), OS (p = 0.001, log-rank test), and LC (p = 0.028, log-rank test) in patients treated with definitive (chemo-) radiotherapy, whereas a significant association in patients undergoing surgery and postoperative radiotherapy was not detected. The pre-treatment CRP level seems to represent a prognostic factor for CSS, OS, and LC in patients with oral and oropharyngeal cancer, particularly in those treated with definitive (chemo-) radiotherapy. Additional large-scale prospective studies are warranted to confirm and extend our findings.

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“…The CAR was found to be a more accurate independent prognostic indicator than other indicators such as GPS, NLR, and PLR in predicting prognosis of various types of cancer. [21][22][23] However, to the best of our knowledge, the prognostic value of CAR in ENKTL has never been investigated. Therefore, we performed the retrospective analysis with a comparatively large sample size to evaluate the prognostic significance of CAR in patients with ENKTL, and we also developed an easily applicable prognostic nomogram based on NKPI with readily accessible parameters for the estimation of clinical outcome in ENKTL.…”

Section: Introductionmentioning

confidence: 99%

High C-Reactive Protein to Albumin Ratio Predicts Inferior Clinical Outcomes in Extranodal Natural Killer T-Cell Lymphoma

Tao

Song

et al. 2020

Dose-Response

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Objective: The prognostic value of C-reactive protein to albumin ratio (CAR) has been identified in several cancers but not in extranodal natural killer T-cell lymphoma (ENKTL) as yet. We aimed to evaluate the prognostic value of CAR in ENKTL. Methods: A retrospective study with 246 patients with ENKTL was performed to determine the prognostic value of pretreatment CAR and examine the prognostic performance of CAR incorporating with International Prognostic Index (IPI) or natural killer/T-cell lymphoma prognostic index (NKPI) by nomogram. Results: The Cox regression analyses showed that high CAR (>0.3) independently predicted unfavorable progression-free survival (PFS, P = .011) and overall survival (OS, P = .012). In the stratification analysis, the CAR was able to separate patients into different prognoses regarding both OS and PFS in Ann Arbor stage I+II as well as III+IV, IPI score 0 to 1, and NKPI score 1 to 2 subgroups (all P < .05). Additionally, the predictive accuracy of the IPI-based nomogram incorporating CAR, albumin to globulin ratio (AGR), and IPI for OS and PFS appeared to be lower than the NKPI-based nomogram incorporating CAR, age, AGR, extranodal site, and NKPI. Conclusion: Pretreatment CAR is a simple and easily accessible parameter for independently predicting OS and PFS in patients with ENKTL.

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Prognostic value of C‐reactive protein/albumin ratio for patients with hypopharyngeal and laryngeal cancer undergoing invasive surgery involving laryngectomy

Cited by 25 publications

References 40 publications

A retrospective study on the prognostic value of preoperative C-reactive protein to albumin ratio in patients with oral cavity squamous cell carcinoma

A retrospective study on the prognostic value of preoperative C-reactive protein to albumin ratio in patients with oral cavity squamous cell carcinoma

The Pre-Treatment C-Reactive Protein Represents a Prognostic Factor in Patients with Oral and Oropharyngeal Cancer Treated with Radiotherapy

High C-Reactive Protein to Albumin Ratio Predicts Inferior Clinical Outcomes in Extranodal Natural Killer T-Cell Lymphoma

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