title: The C-Reactive Protein to Albumin Ratio as a Predictor of Severe Side Effects of Adjuvant Chemotherapy in Stage III Colorectal Cancer Patients.
abstract: OBJECTIVE
  Adjuvant chemotherapy (AC) has been reported to improve the prognosis for patients with Stage III colorectal cancer (CRC). However, some patients experience severe side effects and must stop AC. The C-reactive protein (CRP) to albumin ratio (CAR) is a novel inflammation-based score that could reflect the patient's general condition. The aim of this study was to evaluate the predictive value of the CAR for side effects of AC in CRC.
  
  
  METHODS
  A total of 136 CRC patients who received AC were retrospectively analyzed. The patients were subdivided into two groups by the CAR level (CAR ≥0.1, n = 30; CD < 0.1, n = 106).
  
  
  RESULTS
  The presence of lymphatic invasion, severe side effects, and discontinuation of AC were associated with high CAR levels (p = 0.02, <0.01, and 0.02; respectively). High levels of the Glasgow Prognostic Score (GPS) and the neutrophil to lymphocyte ratio (NLR) appeared to be associated with the CAR (p = 0.04, p<0.01; respectively). Multivariate analysis identified CAR≥0.1 (HR: 7.06, 95% CI: 2.51-19.88, p<0.01) as a significant determinant of severe side effects of AC. CAR had the highest area under the curve (0.79) among several inflammation-based scores.
  
  
  CONCLUSIONS
  The present study showed that the CAR is a novel and promising inflammation-based score for ≥ grade 3 side effects of AC in node-positive CRC.
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Sakamoto, Nagasaki, Japan.
authors.forename: Tetsuro
authors.identifier: http://orcid.org/0000-0001-9429-3227
authors.initials: T
authors.lastname: Tominaga
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Sakamoto, Nagasaki, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nonaka
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Sakamoto, Nagasaki, Japan.
authors.forename: Yorihisa
authors.initials: Y
authors.lastname: Sumida
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Sakamoto, Nagasaki, Japan.
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Hidaka
authors.affiliation: Department of cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Science, Sakamoto, Nagasaki, Japan.
authors.forename: Terumitsu
authors.initials: T
authors.lastname: Sawai
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Sakamoto, Nagasaki, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagayasu
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D002097:C-Reactive Protein / Q000032:analysis*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis*
chemical_list: D000970:Antineoplastic Agents; D012709:Serum Albumin; D002097:C-Reactive Protein