Prognostic role of C‐reactive protein to albumin ratio in lung cancer: An updated systematic review and meta‐analysis
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SUBMITTER: Lu Z
PROVIDER: S-EPMC10914016 | biostudies-literature | 2023 Aug
REPOSITORIES: biostudies-literature
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Project description:BackgroundsThe inflammatory biomarker "C-reactive protein to albumin ratio (CAR)" has been reported to significantly correlate to a variety of human cancers. However, there are conflicting results regarding the prognostic value of CAR in colorectal cancer. Previous studies mainly assessed patients in Eastern countries, so their findings may not be applicable to the Western population. Therefore, this updated meta-analysis aimed to investigate the prognostic value of pre-treatment CAR and outcomes of patients with colorectal cancer.MethodsWe conducted a systematic search for eligible literature until October 31, 2020, using PubMed and Embase databases. Studies assessing pre-treatment CAR and outcomes of colorectal cancer were included. Outcome measures included overall survival, disease-free survival, progression-free survival, and clinicopathological features. The pooled hazard ratios (HR) with 95% confidence intervals (CI) were used as effective values.ResultsA total of 15 studies involving 6329 patients were included in this study. The pooled results indicated that a high pre-treatment CAR was associated with poor overall survival (HR 2.028, 95% CI 1.808-2.275, p < 0.001) and poor disease-free survival/progression-free survival (HR 1.768, 95% CI 1.321-2.365, p < 0.001). Subgroup analysis revealed a constant prognostic value of the pre-treatment CAR despite different study regions, sample size, cancer stage, treatment methods, or the cut-off value used. We also noted a correlation between high pre-treatment CAR and old age, male sex, colon cancer, advanced stage (III/IV), large tumor size, poor differentiation, elevated carcinoembryonic antigen levels, neutrophil-to-lymphocyte ratio, and the modified Glasgow prognostic score.ConclusionsHigh pre-treatment CAR was associated with poor overall survival, disease-free survival, and progression-free survival in colorectal cancer. It can serve as a prognostic marker for colorectal cancer in clinical practice.
| S-EPMC8088626 | biostudies-literature
Project description:This study aims to investigate the prognostic value of pretreatment C-reactive protein/albumin ratio (CAR) in human malignancies by an updated meta-analysis.PubMed, Web of Science, Cochrane Library and Wanfang databases were searched. Pooled hazard ratios (HRs) and odds ratios (ORs) with their corresponding 95% confidence intervals (CIs) were used as effective values.A total of 25 studies with 12,097 patients were included in this meta-analysis. Pooled results showed that high pretreatment CAR was associated with poor overall survival (OS) (HR =1.99, 95% CI: 1.65-2.40, P=0.000) and poor disease-free survival (HR =1.55, 95% CI: 1.34-1.79, P=0.000). In addition, high pretreatment CAR was associated with increased 5-year mortality (OR =2.74, 95% CI: 2.11-3.55, P=0.000). Moreover, subgroup analysis demonstrated that high CAR was associated with poor OS despite variations in publication year, country, sample size, CAR cut-off value and treatment. However, high CAR was associated with poor OS in human malignancies except colorectal cancer (HR =1.64, 95% CI: 0.96-2.80, P=0.069).High pretreatment CAR indicates poor prognosis in human malignancies except colorectal cancer. Thus, pretreatment CAR serves as a prognostic marker in human malignancies and could be used in the evaluation of prognosis in clinical work.
| S-EPMC5488759 | biostudies-other
Project description:C-reactive protein/albumin ratio (CAR) was originally used as a novel inflammation-based prognostic score in predicting outcomes in septic patients. Recently, more and more studies have reported the prognostic value of pretreatment CAR in solid tumors. However, the results remain controversial rather than conclusive. We conducted a meta-analysis based on 24 studies with 10203 patients to explore the relationship between CAR and survival outcomes in patients with solid tumors. The correlation between CAR and clinicopathological parameters was also assessed. Hazard ratio (HR) or odds ratio (OR) with its 95% confidence interval (CI) was applied to be the effect size estimate. The overall results showed that elevated CAR was associated with shorter overall survival (OS) (including 23 studies and 10067 patients) and poorer disease-free survival (DFS) (including 6 studies and 2904 patients). Significant associations between high CAR level and poor OS were also found in the subgroup analyses of study region, cancer type, primary treatment, clinical stage, cut-off selection, sample size, and cut-off value. Moreover, subgroup analyses demonstrated that study region, primary treatment, clinical stage, sample size, and cut-off value did not alter the prognostic value of CAR for DFS. Furthermore, elevated CAR was correlated with certain phenotypes of tumor aggressiveness, such as poor histological grade, serious clinical stage, advanced tumor depth, positive lymph node metastasis, and positive distant metastasis. Together, our meta-analysis suggests that elevated level of serum CAR predicts worse survival and unfavorable clinical characteristics in cancer patients, and CAR may serve as an effective prognostic factor for solid tumors.
| S-EPMC5862627 | biostudies-literature
Project description:BackgroundsBoth pretreatment serum CRP (C-reactive protein) level and ALB (albumin) level have been found to be predictive of survival for multiple malignancies including sarcoma. Since both of the GPS (Glasgow prognostic score) and CAR (C-reactive protein to albumin ratio) are based on the combination of CRP and ALB, we conducted a meta-analysis to evaluate the prognostic role of these two parameters for sarcoma patients.MethodsA detailed literature search was conducted in MEDLINE, Embase, and Cochrane Library for relevant research publications written in English. Patients' clinical characteristics, outcomes of overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were extracted. Pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were combined to evaluate the prognostic role of GPS or CAR.ResultsTwelve articles containing 2695 patients were identified as eligible studies. The results showed that an elevated GPS was significantly correlated with poor OS (HR = 2.42; 95% CI: 1.98-2.94; p < 0.001; fixed-effects model), DSS (HR = 2.28; 95% CI: 1.75-2.97; p < 0.001; fixed-effects model), DSS (HR = 2.28; 95% CI: 1.75-2.97; p < 0.001; fixed-effects model), DSS (HR = 2.28; 95% CI: 1.75-2.97; p < 0.001; fixed-effects model), DSS (HR = 2.28; 95% CI: 1.75-2.97; p < 0.001; fixed-effects model), DSS (HR = 2.28; 95% CI: 1.75-2.97.ConclusionAn elevated GPS is predictive of poor survival in patients with sarcomas and is promising to be used as a factor for risk stratification. A higher CAR value is also predictive of poor survival; however, the optimal CAR cut-off value is still to be determined.
| S-EPMC6969993 | biostudies-literature
Project description:BACKGROUND:In recent years, the role of pre-treatment C-reactive protein/albumin ratio (CAR) in prognosis of esophageal cancer (EC) has been investigated by several studies. This meta-analysis aimed to provide a more accurate and objective assessment of the prognostic value of pre-treatment CAR in EC. METHODS:Studies assessing the role of pre-treatment CAR in prognosis of EC were searched from PubMed, Embase and the Cochrane Library (last update by April 16, 2019). The hazard ratios (HRs) of CAR and the corresponding 95% CIs for overall survival (OS) or cancer-specific survival (CSS) in EC were extracted for pooled analysis. RESULTS:A total of eight observational studies including 2255 patients were collected. The pooled analysis showed that high CAR was related to worse OS in EC (pooled HR?=?1.81; 95% CI?=?1.40-2.35; P?<?0.001). Subgroup analyses showed that the negative correlation between the CAR and OS was consistently demonstrated in subgroups stratified by country, pathological type, and cut-off value (P?<?0.05). However, there was no relation between CAR and OS in subgroup of patients receiving neoadjuvant chemotherapy at a proportion of 100% (HR?=?1.15, 95% CI?=?0.56-2.69; P?=?0.715). In addition, high CAR was also related to worse CSS in EC (pooled HR?=?2.61; 95% CI?=?1.67-4.06; P?<?0.001). CONCLUSIONS:High pre-treatment CAR was an adverse prognostic factor for EC patients. More large-sample clinical trials are still needed to verify the prognostic value of pre-treatment CAR in EC.
| S-EPMC6884775 | biostudies-literature
Project description:IntroductionThe lymphocyte-C-reactive protein ratio (LCR) is a new immunoinflammatory score and prognostic marker, but the relationship between this index and the prognosis of colorectal cancer patients remains controversial.Therefore, aim of the study was to assess the relationship between LCR and prognosis for colorectal cancer patients through a systematic evaluation and meta-analysis.MethodsWe systematically searched PubMed, EMBASE, Web of Science, and Cochrane Library databases for randomized controlled studies and observational studies on the relationship between LCR and prognosis of colorectal cancer patients, all searched from the date of database creation to January 6, 2022.Our primary endpoints observed were overall survival (OS) and disease-free survival (DFS) of colorectal cancer patients, and secondary observables were basic characteristics of included studies, such as country, study duration, sample size, LCR threshold, and pathological characteristics of patients in each study, such as degree of differentiation, gender, tumor location, T stage, and lymphatic metastasis.ResultsA total of 10 case-control studies including 7068 patients were included. Meta-analysis results showed that overall survival (OS) and disease-free survival (DFS) were worse in colorectal cancer patients with lower levels of LCR (HR=0.44, 95% CI=0.38-0.52, P<0.001; HR=0.56, 95% CI=0.41-0.76, P< 0.001).Subgroup analysis based on country, study length, sample size, and LCR threshold showed that lower levels of LCR were all associated with poorer OS (P < 0.05). Regarding pathological characteristics, patients in the low LCR group were generally poorly differentiated (OR=1.79, 95% CI=1.55-2.07, P<0.001), while there was no significant relationship with gender, tumor location, T stage, and lymphatic metastasis (P>0.05).Discussion/conclusionLCR can be used as a prognostic marker for colorectal cancer patients, and patients with lower levels of LCR may have a poor prognosis. Due to the limitation of the number and quality of the included studies, the above findings need to be validated by more high-quality studies.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022296563.
| S-EPMC9296779 | biostudies-literature
Project description:BackgroundThe preoperative C-reactive protein-to-albumin ratio is a novel inflammation-based prognostic marker in various cancers. However, its prognostic role in biliary tract cancer is unknown. We conducted a systematic review and meta-analysis to evaluate the prognostic value of preoperative C-reactive protein-to-albumin ratio in biliary tract cancer.MethodsA systematic search of the literature for studies evaluating the prognostic value of C-reactive protein-to-albumin ratio in patients undergoing surgery for biliary tract cancer was conducted, and a random effects meta-analysis of overall survival and recurrence-free survival was performed.ResultsNine studies with 1292 participants were included. The preoperative C-reactive protein-to-albumin ratio negatively correlated with overall survival (hazard ratio, 2.44 [95% confidence interval: 1.98-2.90]; P < .001) and recurrence-free survival (hazard ratio, 2.73 [95% confidence interval: 2.01-3.70]; P < .001). Subgroup analysis showed that an elevated preoperative C-reactive protein-to-albumin ratio predicted poor overall survival, regardless of the cutoff value, sample size, histological type, and treatment.ConclusionAn elevated preoperative C-reactive protein-to-albumin ratio is significantly associated with poor prognosis in patients undergoing surgery for biliary tract cancer. The C-reactive protein-to-albumin ratio may be an independent prognostic biomarker for overall survival and recurrence-free survival in patients undergoing surgery for biliary tract cancer.
| S-EPMC10238051 | biostudies-literature
Project description:OBJECTIVE:Provide an updated and comprehensive evaluation of the prognostic value of the albumin-fibrinogen ratio (AFR) and the fibrinogen-prealbumin ratio (FPR) for patients with cancer. MATERIALS AND METHODS:Four databases (PubMed, Web of Science, Cochrane Library, and WanFang) were searched. The primary endpoints were overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS). Pooled data were synthesized using StataMP 14 and expressed as hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS:This update examined 19 studies (7282 cases) that assessed the correlation of AFR with cancer prognosis. Pooled univariate and multivariate analyses indicated significant correlations of low AFR with poor OS (HR 2.18, 95%CI 1.87-2.55 and HR 1.75, 95%CI 1.54-2.00, respectively), poor DFS (HR 1.89, 95%CI 1.54-2.32 and HR 1.51, 95%CI 1.29-1.76, respectively), and poor PFS (HR 1.68, 95%CI 1.42-1.99 and HR 1.48, 95%CI 1.16-1.88, respectively). Pooled univariate and multivariate analyses of 6 studies (2232 cases) indicated high FPR significantly correlated with poor OS (HR 2.37, 95%CI 2.03-2.77 and HR 1.97, 95%CI 1.41-2.77, respectively). One study reported that high FPR correlated with poor DFS (univariate analysis: HR 2.20, 95%CI 1.35-3.57; multivariate analysis: HR 1.77, 95%CI 1.04-2.99) and one study reported a correlation of high FPR with poor PFS in univariate analysis alone (HR 1.79, 95%CI 1.11-2.88). CONCLUSION:A low AFR and a high FPR correlated with increased risk of cancer mortality and recurrence. AFR and FPR may be promising prognostic markers for cancers.
| S-EPMC6958612 | biostudies-literature
Project description:BACKGROUND:The prognostic role of neutrophil-to-lymphocyte ratio (NLR) in esophageal cancer (EC) remains controversial. METHODS:The aim of this study was to evaluate the association between NLR and oncologic outcome of EC patients through a meta-analysis. A systematic search was performed in PubMed, Web of Science and Embase for relevant studies. Meta-analysis was performed using hazard ratio (HR) and95% confidence interval (CI) as effect measures. RESULTS:Finally, 33 articles with 11,039patients were included in our study. The synthesized results indicated that the elevated NLR was negatively related to overall survival (OS) (HR?=?1.39, 95% CI: 1.23-1.54). When the patients were stratified according to country, pathological type, treatment strategies, sample size, and different HR estimate method, high NLR was also significantly correlated with poor OS. Similarly, elevated NLR was also associated with shorter disease-free survival (DFS), progress-free survival (PFS), relapse-free survival (RFS), and cancer-specific survival (CSS). CONCLUSION:The elevated pretreatment NLR is associated with poor oncological outcomes in patients with EC. NLR may be a significant predictive biomarker in EC. Further large-cohort studies are needed to confirm these findings.
| S-EPMC6310576 | biostudies-other
Project description:ObjectiveWe aimed to assess whether C-reactive protein to albumin ratio (CAR) is associated with the clinicopathology and prognosis of patients with non-small cell lung cancer (NSCLC) after surgery.MethodsSeveral literature databases were searched for eligible studies in English and Chinese published before September 1, 2022, according to the inclusion and exclusion criteria. The pooled odds ratios (ORs) with 95% confidence interval (CI) were calculated to assess the association of CAR in lung cancer with clinicopathological characteristics including age, sex, smoking status, lymph node metastasis, and American Association of Cancer (AJCC) stage. The pooled hazard ratios (HRs) with 95% CI were calculated to assess the association of CAR with prognosis in lung cancer. Publication bias was assessed using Egger's test.ResultsOverall, 9 studies involving 3,359 NSCLC patients were included in this meta-analysis. The CAR was observed to be higher in males, smokers, and patients with lymph node metastasis and correlated with advanced AJCC stage but not with age. Moreover, a high CAR correlated with poor survival. No publication bias was observed in this meta-analysis.ConclusionsCAR was observed to be a significant biomarker for prognosis and associated with clinicopathological characteristics in patients with NSCLC after surgery.
| S-EPMC9852518 | biostudies-literature