Ratio of C-Reactive Protein/Albumin is An Inflammatory Prognostic Score for Predicting Overall Survival of Patients with Small-cell Lung Cancer

Zhou, Ting; Zhan, Jie; Hong, Shaodong; Hu, Zhihuang; Fang, Wenfeng; Qin, Tao; Ma, Yuxiang; Yang, Yunpeng; He, Xiaobo; Zhao, Yuanyuan; Huang, Yan; Zhao, Hongyun; Zhang, Li

doi:10.1038/srep10481

Cited by 131 publications

(124 citation statements)

References 36 publications

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“…In addition, some recent studies have demonstrated that the CRP/Alb ratio is a promising inflammation-associated prognostic factor in cancer, including liver, lung, gastric, and esophageal cancer [8, 13–17]. In our study, we assessed and compared the prognostic value of the NLR, PLR, mGPS, and CRP/Alb ratio in advanced PC by retrospectively analyzing the pretreatment laboratory data of 233 eligible patients.…”

Section: Discussionmentioning

confidence: 99%

“…These factors are all easily available from peripheral blood samples, including the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), white cell count and C-reactive protein (CRP) combined into the prognostic index (PI), albumin and lymphocyte count in the prognostic nutritional index (PNI), and CRP- and albumin-based factors of the modified Glasgow prognostic score (mGPS) and C-reactive protein/albumin (CRP/Alb) ratio [7–12]. Among these indicators, the CRP/Alb ratio has been reported as a novel reliable marker in different cancers such as lung, liver, gastric, and esophageal cancer [8, 13–16]. However, the role of the CRP/Alb ratio in patients with advanced pancreatic cancer has not previously been elucidated.…”

Section: Introductionmentioning

confidence: 99%

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The C-reactive protein/albumin ratio predicts overall survival of patients with advanced pancreatic cancer

Guo

et al. 2016

Tumor Biol.

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Recent studies have demonstrated the prognostic value of the C-reactive protein/albumin (CRP/Alb) ratio in cancer. However, the role of the CRP/Alb ratio in advanced pancreatic cancer (PC) has not been examined. A retrospective study of 233 patients with advanced PC was conducted. We investigated the relationship between the CRP/Alb ratio, clinicopathological variables, and overall survival (OS). The optimal cutoff point of the CRP/Alb ratio was 0.54. A higher CRP/Alb ratio was significantly associated with an elevated neutrophil-lymphocyte ratio (NLR) (P < 0.001) and higher modified Glasgow prognostic score (mGPS) (P < 0.001). Using univariate analyses, we found that the age (P = 0.009), disease stage (P < 0.001), NLR (P < 0.001), mGPS (P < 0.001), and CRP/Alb ratio (P < 0.001) were significant predictors of OS. Patients with a higher CRP/Alb ratio had a worse OS than patients with a lower CRP/Alb ratio (hazard ratio (HR) 3.619; 95 % CI 2.681–4.886; P < 0.001). However, the CRP/Alb ratio was identified as the only inflammation-based parameter with an independent prognostic ability in the multivariate analyses (P < 0.001). The pretreatment CRP/Alb ratio is a superior prognostic and therapeutic predictor of OS in advanced PC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The C-reactive protein/albumin ratio predicts overall survival of patients with advanced pancreatic cancer

Guo

et al. 2016

Tumor Biol.

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Section: Discussionmentioning

confidence: 99%

“…Serum ALB level reflects the general nutrition status for patients with malignant diseases. Several studies have been conducted by Zhang and his group to demonstrate the prognostic value of ALB and its composite indexes (e.g., the prognosis nutritional index, PNI) for SCLC patients (17)(18)(19).Besides, the present study is the first study to investigate Overall survival time (days) Survival probability Survival probability Survival probabilityZhou et al Modeling the relationship between LDH and prognosis in SCLC © Journal of Thoracic Disease. All rights reserved.…”

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confidence: 99%

Modeling the relationship between baseline lactate dehydrogenase and prognosis in patients with extensive-disease small cell lung cancer: a retrospective cohort study

et al. 2018

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Background: Elevated pretreatment lactate dehydrogenase (LDH) has been reported to be associated with poor survival in small cell lung cancer (SCLC). The present study aimed to investigate the continuous relationship between baseline LDH level and survival in patients with extensive-disease SCLC (ED-SCLC). Results: A total of 132 eligible ED-SCLC patients were analyzed. Elevated LDH at baseline was associated with poor survival (HR =1.92; 95% CI,). An increment of LDH would still raise the risk of death even in abnormal range. Among patients with elevated LDH, those who had relatively higher LDH levels (>370 U/L) would have a poorer prognosis than those with moderately elevated LDH levels (245-370 U/L; median survival time, 114 vs. 274 days; P value of log rank test, 0.007).Conclusions: LDH is a significant prognostic biomarker for ED-SCLC patients. The interpretation of continuous relationship between LDH and patients' survival can provide more accurate information for clinical practice. In recent decades, novel approaches of immunotherapy have brought light to cancer treatment (4,5). And trials for investigating the efficacy and safety of immunotherapy with or without chemotherapy in SCLC patients are ongoing (6,7).Predicting prognostic risks of SCLC patients through reliable biomarkers can provide information for disease monitoring and treatment evaluation, which will contribute to the exploration of novel treatments. Lactate dehydrogenase (LDH) is the key enzyme in glycolytic pathway, which is the main source of energy in activities of rapid proliferation and distant metastases for tumor cells. When tissue damage occurs because of tumor activities, LDH will be released from intracellular microenvironment and then lead to an abnormal elevation of serum LDH (8). Therefore, measurements of serum LDH levels can reflect the intensity of tumor activities and thus can be used as a prognostic biomarker. Zhang et al. (9) conducted a metaanalysis involving 4,785 SCLC patients from 28 studies to investigate the prognostic value of baseline LDH for SCLC patients. Their results indicated that patients with an abnormal elevation of serum LDH at baseline would have a 1.45 times higher risk of death than those with normal LDH level (HR =1.45; 95% confidence interval (CI), 1.27-1.66).However, measurements of LDH were all treated as binary outcomes in above studies with a cutoff value at the upper limit of normal range. In that way, it would be impossible to explore the continuous relationship between baseline LDH and survival; namely, different LDH levels within the same group would be regarded as to have the same risk of death.Modeling the relationship between exposure of risk factors and disease outcomes can provide more accurate information for clinical practice. Zhou et al. (10) found nonlinear associations between biomarkers and prognosis in resectable pancreatic ductal adenocarcinoma (PDAC) patients. Their results suggested that a preoperative Carbohydrate antigen 19-9 (CA19-9) level of 100 U/mL and a carcinoembryoni...

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“…CRP is an acute phase response protein, and an increase in CRP is related to a worsening inflammatory status and progression of the cancer13, whereas a decrease in alb level is related to a chronic inflammatory state and poor nutritional status14. Recently, a new inflammation-based prognostic score, the CRP/alb ratio, was introduced and is reportedly comparable or superior to other inflammation-based prognostic scores in predicting prognosis in malignant tumors such as those of the liver and lung15161718. However, whether or not the CRP/alb ratio correlates with prognosis in patients with oral squamous cell carcinoma (OSCC) has yet to be determined.…”

Section: Introductionmentioning

confidence: 99%

C-reactive protein/albumin ratio as prognostic score in oral squamous cell carcinoma

Park

Kim

2016

J Korean Assoc Oral Maxillofac Surg

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ObjectivesMany studies have examined histopathological factors and various prognostic scores related to inflammation to predict outcomes. Here, we examined the prognostic value of the C-reactive protein/albumin (CRP/alb) ratio in oral squamous cell carcinoma (OSCC).Materials and MethodsThis retrospective study included 40 patients with OSCC. Using univariate and multivariate analyses, we focused on the correlation of the CRP/alb ratio with clinicopathological characteristics and with overall survival. We then compared five inflammation-based prognostic scores, CRP/alb ratio, modified Glasgow Prognostic Score (mGPS), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and prognostic nutritional index (PNI), based on receiver operating characteristic (ROC) curves.ResultsThe optimal cut-off value for the CRP/alb ratio was 0.085. The group with a high CRP/alb ratio had a high TNM clinical stage (P=0.002) and larger primary tumors (P=0.029), with statistically significant differences in lymph node metastasis and distant metastasis. In addition, when the CRP/alb ratio was high, multivariate analysis showed a lower survival rate (P=0.002; hazard ratio=6.078), and the ROC curve showed more outstanding discriminatory ability regarding overall survival compared to other inflammation-based prognostic scores.ConclusionThe CRP/alb ratio can be an independent prognostic factor when predicting prognosis in OSCC and has good prognostic ability.

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Ratio of C-Reactive Protein/Albumin is An Inflammatory Prognostic Score for Predicting Overall Survival of Patients with Small-cell Lung Cancer

Cited by 131 publications

References 36 publications

The C-reactive protein/albumin ratio predicts overall survival of patients with advanced pancreatic cancer

The C-reactive protein/albumin ratio predicts overall survival of patients with advanced pancreatic cancer

Modeling the relationship between baseline lactate dehydrogenase and prognosis in patients with extensive-disease small cell lung cancer: a retrospective cohort study

C-reactive protein/albumin ratio as prognostic score in oral squamous cell carcinoma

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