Clinicopathologic and prognostic significance of C-reactive protein/albumin ratio in patients with solid tumors: an updated systemic review and meta-analysis
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Jiayuan Wu1, Wenkai Tan2, Lin Chen3, Zhe Huang4 and Shao Mai2
1Clinical Research Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, PR China
2Department of Gastroenterology, The Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, PR China
3Department of Cardiac Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, PR China
4Department of Gastrointestinal Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, PR China
Jiayuan Wu, email: firstname.lastname@example.org
Keywords: C-reactive protein/albumin ratio; prognosis; clinicopathological features; solid tumors; undated meta-analysis
Received: September 15, 2017 Accepted: December 05, 2017 Published: January 11, 2018
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.
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