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Inicio Medicina Clínica (English Edition) Preoperative C-reactive protein/albumin ratio to predict mortality and recurrenc...
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Vol. 153. Issue 5.
Pages 183-190 (September 2019)
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Vol. 153. Issue 5.
Pages 183-190 (September 2019)
Original article
DOI: 10.1016/j.medcle.2018.11.024
Preoperative C-reactive protein/albumin ratio to predict mortality and recurrence of patients with hepatocellular carcinoma after curative resection
Relación proteína C reactiva/albúmina preoperatoria para predecir la mortalidad y la recurrencia de los pacientes después de la resección curativa de carcinoma hepatocelular
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Yiyue Rena,, Xiaoxiao Fana,, Guoqiao Chena, Daizhan Zhoub,c,d, Hui Lina,
Corresponding author
369369@zju.edu.cn

Corresponding authors.
, Xiujun Caia,
Corresponding author
srrsh_cxj@zju.edu.cn

Corresponding authors.
a Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine and Innovation Center for Minimally Invasive Technique and Device, Zhejiang University, Hangzhou, China
b Key Laboratory of Arrhythmias of the Ministry of Education of China, East Hospital, Tongji University School of Medicine, China
c Institute of Medical Genetics, Tongji University, Shanghai, China
d Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, China
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Tables (3)
Table 1. Relationships of the CRP/Alb ratio with clinicopathological characteristics of included patients.
Table 2. Univariate and multivariate analysis of prognostic factors of overall survival and tumor free survival.
Table 3. Comparison of the areas under the ROC curves for different inflammation-based prognostic scores.
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Abstract
Background & objectives

Recent studies have shown that the C-reactive protein-to-albumin ratio (CAR) can predict the mortality in patients with hepatocellular carcinoma (HCC). The aim of the present study was to investigate the utility of preoperative CAR for predicting postoperative overall and tumor free survival among HCC patients after radical surgery.

Methods

Preoperative neutrophil-to-lymphocyte ratio (NLR), clinicopathological parameters, laboratory data and patient demographics of 187 patients with HCC receiving initial radical liver resection from Sir Run Run Shaw hospital were evaluated. Multivariate analyses were performed to identify clinical characteristics associated with overall survival (OS) and tumor free survival (TFS). Subsequently, the prognostic value of CAR was evaluated using the area under the curve (AUC) compared with other systemic inflammation-based prognostic scores.

Results

Multivariate analysis revealed that the tumor number [hazard ratio (HR)=2.668; p=0.018] was independently associated with OS. While, the CRP/Alb ratio [HR=0.477; p=0.006] and the tumor number [HR=2.458; p=0.006] were significantly associated with TFS. The AUC values of the CRP/Alb ratio (6 months: 0.868; 12 months: 0.787; 36 months: 0.680) were higher than those of the GPS, mGPS and NLR at all time points in OS.

Conclusion

Preoperative CRP/Alb ratio is an independent prognostic marker with tumor free survival in patients with HCC after curative resection and the prognostic ability was comparable to other applied inflammation-based prognostic scores in both overall and tumor-free survival, especially at the early stage.

Keywords:
C-reactive protein/albumin ratio
Prognostic factor
Hepatocellular carcinoma
Surgery
Resumen
Antecedentes y objetivos

Estudios recientes han demostrado que la relación proteína C reactiva/albúmina (CAR) puede predecir la mortalidad en pacientes con carcinoma hepatocelular (HCC). El objetivo del presente estudio fue investigar la utilidad de la CAR preoperatoria para predecir la supervivencia postoperatoria general y libre de tumores entre los pacientes con HCC después de la cirugía radical.

Métodos

Se evaluaron la relación preoperatoria de neutrófilos a linfocitos (NLR), los parámetros clínico-patológicos, los datos de laboratorio y los datos demográficos de 187 pacientes con HCC que recibieron resección hepática radical inicial en el Hospital Sir Run Run Shaw. Se realizaron análisis multivariables para identificar las características clínicas asociadas con la supervivencia general (SG) y la supervivencia libre de tumor (SST). Posteriormente, se evaluó el valor pronóstico de la CAR utilizando el área bajo la curva (AUC) en comparación con otras puntuaciones de pronóstico basadas en la inflamación sistémica.

Resultados

El análisis multivariado reveló que el número de tumores (cociente de riesgos instantáneos [CRI]: 2,668; p=0,018) se asoció de manera independiente con la SG. Mientras, la relación CRP/Alb (hazard ratio [HR]: 0,477; p=0,006) y el número de tumores (HR: 2,458; p=0,006) se asociaron significativamente con SST. Los valores de AUC de la relación CRP/Alb (6 meses: 0,868; 12 meses: 0,787 y 36 meses: 0,680) fueron superiores a los del GPS, mGPS y NLR en todos los puntos temporales en SG.

Conclusión

La proporción preoperatoria de CRP/Alb no solo puede predecir la supervivencia general en pacientes con HCC después de la resección curativa, sino que también tiene un rendimiento favorable en la predicción de recidiva tumoral, especialmente en las primeras etapas.

Palabras clave:
Relación proteína C reactiva/albúmina
Factor pronóstico
Carcinoma hepatocelular
Cirugía

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