title: A Novel Inflammation-Based Prognostic Score, the C-Reactive Protein/Albumin Ratio Predicts the Prognosis of Patients with Operable Esophageal Squamous Cell Carcinoma.
abstract: BACKGROUND
  Inflammation-based prognostic scores such as the neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), Glasgow prognostic score (GPS), and modified GPS (mGPS) have been reported to have prognostic value in patients with many types of cancer, including esophageal squamous cell carcinoma (ESCC). However, the role of the C-reactive protein/Albumin (CRP/Alb) ratio in ESCC has not yet been evaluated.
  
  
  METHODS
  A total of 468 patients suffering from histologically proven ESCC were enrolled between January 2000 and July 2010. The GPS, mGPS, NLR, PLR and CRP/Alb ratios were tested together with established prognostic factors in univariate and multivariate Cox regression analyses of overall survival (OS).
  
  
  RESULTS
  The optimal cutoff level for the CRP/Alb ratio was 0.50. The CRP/Alb ratio (continuous) had higher AUC values at 12 months (0.796), 24 months (0.805), and 36 months (0.815) than the NLR, GPS and mGPS. In univariate analysis, the 5-year OS rate for patients with a CRP/Alb ratio > 0.50 was 43.4%, while the rate for patients with a CRP/Alb ratio ≤ 0.50 was 17.7% (P < 0.0001). In multivariate analysis, patients with a CRP/Alb ratio > 0.50 had worse survival than patients with a CRP/Alb ratio ≤ 0.50 (HR: 2.44; 95% CI: 1.82-3.26; P < 0.0001).
  
  
  CONCLUSIONS
  In summary, to the best of our knowledge, this is the first study to identify the CRP/Alb ratio as a novel inflammation-based prognostic factor in a large group of ESCC patients. The prognostic value of the CRP/Alb ratio needs to be verified in prospective multicenter studies.
authors.affiliation: Department of Medical Oncology, Zhejiang Cancer Hospital, 38 Guangji Road, Hangzhou City, China.
authors.forename: Xiao-Ling
authors.initials: XL
authors.lastname: Xu
authors.affiliation: Digestive Department, Hanggan Hospital, Hangzhou City, China.
authors.forename: Hui-Qin
authors.initials: HQ
authors.lastname: Yu
authors.affiliation: Department of Respiration, The Second of Yuhang People's Hospital, Hangzhou City, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Hu
authors.affiliation: Department of Clinical Laboratory, Zhejiang Cancer Hospital, 38 Guangji Road, Hangzhou City, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Song
authors.affiliation: Department of Clinical Laboratory, Zhejiang Cancer Hospital, 38 Guangji Road, Hangzhou City, China.
authors.forename: Wei-Min
authors.initials: WM
authors.lastname: Mao
mesh_terms: D001792:Blood Platelets / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000378:metabolism*; D019937:Diagnostic Techniques and Procedures / Q000706:statistics & numerical data; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000378:metabolism*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000378:metabolism*; D053208:Kaplan-Meier Estimate; D008214:Lymphocytes / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils / Q000378:metabolism; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012709:Serum Albumin / Q000378:metabolism*
chemical_list: D012709:Serum Albumin; D002097:C-Reactive Protein