C‐REACTIVE PROTEIN‐TO‐ALBUMIN RATIO IS AN INDEPENDENT POOR PROGNOSIS AND IMPROVING NCCN‐IPI SCORE IN NEWLY DIAGNOSED DIFFUSE LARGE B‐CELL LYMPHOMA: A CLINICAL ANALYSIS OF 414 CASES

Abstract

Introduction: In recent years, increasing evidences have validated that cancer-associated systemic inflammation and malnutrition had exact prognostic impact on the majority of patients with malignancies. Numerous circulating inflammatory and nutritive indicators have been proposed as prognostic indicators for malignant tumors including DLBCL. Among them, the Glasgow Prognostic Score (GPS), the modified Glasgow Prognostic Score (mGPS) are novel inflammatory indicators which consist of C-reactive protein (CRP) and albumin (ALB) and reflect both the systematic inflammatory response and nutritional status. Recently, the ratio of CRP-to-ALB (CAR) has been identified as another serum-based inflammatory indicator and several studies have reported that the CAR is significantly related to prognosis in various types of cancers. Methods: Four hundred and fourteen newly-diagnosed DLBCL patients were enrolled in the retrospective study. The univariate and multivariate Cox proportional hazards models were established for the estimation of prognostic factors. Receiver-operator characteristic (ROC) curves and the corresponding areas under the curve (AUC) were calculated to predicted probability of variables. Results: With a median follow-up of 40 months (range, 0 to 105 months), patients with higher CAR displayed unfavorable progression-free survival (PFS) (P<0.001) and overall survival (OS) (P<0.001) (Figure 1). Multivariate Cox regression analysis validated that CAR was independent risk factor for both PFS (HR, 1.548; 95% CI, 1.224 to 1.958; P<0.001) and OS (HR, 1.763; 95% CI, 1.291 to 2.335; P<0.001). It was demonstrated that CAR + NCCN-IPI had a superior prognostic significance than NCCN-IPI alone (P=0.0028 for PFS, P=0.0011 for OS) Keywords: diffuse large B-cell lymphoma (DLBCL).