title: Clinical Significance of the C-Reactive Protein to Albumin Ratio for Survival After Surgery for Colorectal Cancer.
abstract: OBJECTIVE
  This study was designed to estimate the clinical significance of the C-reactive protein (CRP)/albumin ratio (CAR) for prediction of postoperative survival in patients with colorectal cancer (CRC).
  
  
  BACKGROUND
  The Glasgow Prognostic Score (GPS), calculated from the serum levels of CRP and albumin, is well known to be a valuable inflammation-based prognostic system for several types of cancer. A recent study has demonstrated that the CAR is also useful for prediction of treatment outcome in patients with hepatocellular carcinoma.
  
  
  METHODS
  Uni- and multivariate analyses using the Cox proportional hazards model were performed to detect the clinical characteristics that were most closely associated with overall survival (OS). All recommended cutoff values were defined using receiver operating characteristic curve analyses. Kaplan-Meier analysis was used to compare OS curves between the two groups.
  
  
  RESULTS
  A total of 627 patients who had undergone elective CRC surgery were enrolled. Multivariate analysis using the results of univariate analyses demonstrated that CAR (>0.038/≤0.038) was associated with OS (hazard ratio 2.596; 95% confidence interval 1.603-4.204; P < 0.001) along with pathological differentiation (others/well or moderately), carcinoembryonic antigen level (>8.7/≤8.7, ng/ml), stage (III, IV/0, I, II), neutrophil to lymphocyte ratio (NLR) (>2.9/≤2.9), and GPS (2/0, 1). Kaplan-Meier analysis and log rank test demonstrated a significant difference in OS curves between patients with low CAR (≤0.038) and those with high CAR (>0.038; P < 0.001).
  
  
  CONCLUSIONS
  CAR is as useful for predicting the postoperative survival of patients with CRC as previously reported inflammation-based prognostic systems, such as GPS and NLR.
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan. mm-ishizuka@umin.ac.jp.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Ishizuka
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nagata
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan.
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan.
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Iwasaki
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan.
authors.forename: Norisuke
authors.initials: N
authors.lastname: Shibuya
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kubota
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D002272:Carcinoembryonic Antigen / Q000378:metabolism; D015179:Colorectal Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D003107:Colorectal Surgery / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis*; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D012709:Serum Albumin; D002097:C-Reactive Protein