Abstract
BackgroundAlthough the C-reactive protein-to-albumin ratio (CAR) can predict poor outcomes in assorted cancers, its prognostic value in oral cavity squamous cell carcinoma (OSCC) remains unclear. We explored the value of preoperative CAR in predicting clinical outcomes in OSCC patients treated with radical surgery.MethodsAll the recommended cutoff values were defined analyzing receiver operating characteristic curves or overall survival (OS). Dichotomization was performed on the basis of optimal CAR cutoff, and we compared the clinicopathological features between groups. Kaplan–Meier analysis was also performed to compare OS curves between the two groups. Univariate and multivariate analyses using the Cox proportional hazards model were conducted to find the clinical characteristics that were most closely correlated with disease free survival (DFS) and overall survival (OS). A nomogram incorporated CAR and several clinicopathological factors was established to predict prognosis and its accuracy was evaluated using concordance index (c-index).ResultsIn this retrospective study, a total of 326 patients with newly diagnosis of OSCC and received primary surgery between 2008 and 2017 were enrolled. Through the executed ROC curve analyses, the optimal CAR cutoff derived was 0.195 (area under the curve = 0.718, p < 0.001), with this cutoff exhibiting a discrimination ability superior to that of other inflammation-based prognostic scores after comparing the area under curves. Multivariate analysis demonstrated that CAR (≥0.195/<0.195) was associated with OS (hazard ratio 3.614; 95% CI [1.629–8.018]; p = 0.002) and DFS (hazard ratio 1.917; 95% CI [1.051–3.863]; p = 0.029). Kaplan–Meier analysis and log rank test revealed a significant difference in DFS and OS curves between patients with low CAR (<0.195) and those with high CAR (≥0.195; both p < 0.001). The c-index of the nomogram based on TNM system alone was 0.684 and could be increased to 0.801 if CAR and other clinicopathological factors were included.ConclusionsPreoperative CAR could constitute an independent prognostic indicator for OS and DFS prediction in OSCC patients treated with curative surgery. The established nomogram that incorporated CAR and prognostic factors might increase the accuracy of prognostic prediction for patients with OSCC.
Highlights
Despite the recent decline in betel quid use, oral cavity squamous cell carcinoma (OSCC) incidence has continued to increase in Taiwan (Liao et al, 2014); this increase may be explained by the long-term carcinogenic effect engendered by betel quid chewing and by the detrimental effects engendered by alcohol consumption and cigaret smoking (Adel et al, 2016)
In patients with OSCC treated with curative intent, we examined the prognostic significance of the following preoperative systemic inflammatory indices: C-reactive protein-to-albumin ratio (CAR), modified Glasgow prognostic score (mGPS), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR), highlighting the correlation of CAR with clinicopathological characteristics and treatment outcomes
T4 classification, extracapsular nodal extension (ENE), poor cell differentiation, depth of invasion (DOI) of >10 mm, need for adjuvant chemoradiotherapy, mGPS of 1 or 2, CAR of ≥0.195, NLR of ≥4.505, and PLR of ≥165.85 were significantly associated with poor disease free survival (DFS)
Summary
Preoperative CAR could constitute an independent prognostic indicator for OS and DFS prediction in OSCC patients treated with curative surgery. The established nomogram that incorporated CAR and prognostic factors might increase the accuracy of prognostic prediction for patients with OSCC.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
