Prognostic value of the C-reactive protein/Albumin Ratio (CAR) in patients with operable soft tissue sarcoma

Abstract

BackgroundThe preoperative C-reactive protein/Albumin ratio (CAR) is valuable for predicting the prognosis of patients with various types of cancers. The aim of the present study is to investigate the prognostic value of the preoperative CAR and compare it with other systemic inflammatory response markers in patients with soft tissue sarcoma (STS).MethodsThis retrospective study included 206 patients with STS. The optimal cutoff value of the CAR was determined by receiver operating characteristic (ROC) analysis. The impact of the CAR and other clinicopathological features on overall survival (OS) and disease-free survival (DFS) was evaluated using univariate and multivariate Cox regression analyses. Kaplan-Meier survival analyses were used to compare groups classified by the CAR. Additionally, the area under the receiver operating characteristic curve (AUC) was used to compare the predictive ability of the CAR, high-sensitivity modified Glasgow prognostic score (Hs-mGPS), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR).ResultsThe optimal cut-off value of the CAR was 0.1035 according to the ROC analysis. An increased CAR (≥0.1035) was significantly associated with older age, larger tumor size, deep tumor location, higher tumor grade and more advanced American Joint Committee on Cancer (AJCC) stage (all P<0.05). Patients with an elevated CAR (≥0.1035) exhibited a shorter median survival time and lower 5-year OS rate than those with a CAR<0.1035 (68.2 vs 115.8 months, P = 0.000; 44.6% vs 80.9%, P = 0.000, respectively). The results of a multivariate analysis indicated that the CAR (Hazard ratio (HR) 2.47, 95% confidence interval (CI) 1.47-4.14, P = 0.001) was an independent prognostic factor for OS along with tumor grade (P<0.05). Additionally, the CAR exhibited a greater AUC value (0.662) than the NLR and PLR, but the value was equal to the Hs-mGPS.ConclusionsThe preoperative CAR is an independent prognostic factor predicting prognosis in STS and exhibits superior prognostic ability compared to the established inflammation-based prognostic indices.

The Prognostic Role of Glasgow Prognostic Score and C-reactive Protein to Albumin Ratio for Sarcoma: A System Review and Meta-Analysis

“…This exceptional study was excluded because the data cannot be adequately transformed. Finally, 12 eligible studies with 2695 patients were included in this meta-analysis [30][31][32][33][34][35][36][37][38][39][40][41]. There is no disagreement among the two investigators during the data extraction process.…”

“…The main features of the 12 included studies are summarized in Table 1. In short, four studies were conducted in Europe (1 in UK and 3 in Denmark) [30,32,35,40], while the other eight were in Asia (6 in China and 2 in Japan) [31,33,34,[36][37][38][39][40][41]. The sample size ranged from 83 to 888, while the follow-up time ranged from 20.3 months to 19 years.…”

“…Five studies focused on bone sarcoma patients [30,31,33,34,41], another five focused on soft tissue sarcoma patients [35][36][37][38][39], and the other two focused on both bone and soft tissue sarcoma patients [32,40]. Five of the 12 included studies declared that patients with medical conditions known to affect systemic inflammation status were excluded [31,33,34,36,38]. According to the Newcastle-Ottawa Scale criteria, all 12 articles were rated as high quality (Table 1).…”

“…Eleven studies investigated the prognostic value of GPS for sarcoma patients. Seven of them reported the prognostic role of GPS for OS [30,31,33,34,36,38,39], four of them reported the prognostic role of GPS for DSS [30,32,35,40], and another four reported the prognostic role of GPS for DFS [32,[36][37][38]. Nine of the eleven studies evaluated traditional GPS, one [32] evaluated mGPS (modified GPS), two [36,37] evaluated Hs-mGPS (high sensitive modified GPS), and the other one [38] evaluated both traditional GPS and mGPS.…”

“…The prognostic significance of GPS and CAR has also been investigated in sarcoma patients, and controversial results have also been reported [30][31][32][33][34][35][36][37][38][39][40][41][42]. To our knowledge, no system review or meta-analysis has been conducted on this subject for sarcoma.…”