title: The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma.
abstract: BACKGROUND
  The C-reactive protein/albumin (CRP/Alb) ratio is associated with outcomes in septic patients. We investigated the prognostic value of the CRP/Alb ratio in patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  We retrospectively evaluated 186 newly diagnosed HCC patients and investigated the correlations among the pretreatment CRP/Alb ratio, clinicopathological parameters, and overall survival (OS). Multivariate analyses were performed to identify the clinicopathological parameters associated with OS. Subsequently, we evaluated the prognostic value of the CRP/Alb ratio compared with other inflammation-based prognostic scores [Glasgow Prognostic Score (GPS), modified GPS (mGPS), and neutrophil lymphocyte ratio (NLR)] using the area under the curve (AUC).
  
  
  RESULTS
  The optimal cutoff level for the CRP/Alb ratio was 0.037. An elevated CRP/Alb ratio (≥0.037) was associated with tumor progression and reduced liver functional reserve. In the multivariate analysis, the CRP/Alb ratio [hazard ratio (HR) 3.394; p < 0.0001], Cancer Liver Italian Program score (HR 2.686; 95% CI 2.122-3.401; p < 0.0001), and vascular invasion (HR 3.376; 95% CI 1.594-7.151; p = 0.001) were independently associated with OS (HR 3.394; p < 0.0001). The CRP/Alb ratio had higher AUC values at 6 months (0.844), 12 months (0.863), and 24 months (0.82) compared with the GPS, mGPS, and NLR.
  
  
  CONCLUSIONS
  The CRP/Alb ratio might be an independent prognostic marker in patients with HCC, and may have comparable prognostic ability to other established inflammation-based prognostic scores. The prognostic value of this novel inflammation-based prognostic score needs to be verified in patients with other types of cancer.
authors.affiliation: Division of Gastroenterology and Hepatology, The Jikei University Daisan Hospital, Komae-Shi, Tokyo, Japan, aki.kino@jikei.ac.jp.
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Kinoshita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Onoda
authors.forename: Nami
authors.initials: N
authors.lastname: Imai
authors.forename: Akira
authors.initials: A
authors.lastname: Iwaku
authors.forename: Mutumi
authors.initials: M
authors.lastname: Oishi
authors.forename: Ken
authors.initials: K
authors.lastname: Tanaka
authors.forename: Nao
authors.initials: N
authors.lastname: Fushiya
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Nishino
authors.forename: Masato
authors.initials: M
authors.lastname: Matsushima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000032:analysis*; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000150:complications / Q000401:mortality / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000209:etiology / Q000401:mortality; D008113:Liver Neoplasms / Q000097:blood / Q000150:complications / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000418:Albumins; D014408:Biomarkers, Tumor; D002097:C-Reactive Protein