Abstract
Aim To evaluate the prognostic significance of C-reactive protein to albumin ratio (CAR) for clinical outcomes in hepatocellular carcinoma (HCC) patients. Material and Methods. Eligible studies were searched by PubMed, MedLine, the Cochrane Library, from January 1, 2000, to June 30, 2019, investigating the prognostic value of CAR in patients with HCC. Primary endpoint was OS. Hazard ratio (HR) with 95% confidence interval (CI) was used to determine the effect size. Results 7 records including 2208 patients published since 2014 were enrolled into our meta-analysis. Clinicopathological characteristics were also correlated with the level of CAR. The pooled HR for the OS rate between low and high CAR groups was 2.13 (95% CI 1.70~2.68, P < 0.00001) using a random model, but sensitivity analysis showed that the pooled HR for the OS rates did not change substantially after removal of any included study. As for patients receiving surgery, the pooled HR for the OS rate between low and high CAR groups was 2.04 (95% CI 1.59~2.61, P < 0.00001). Subgroup analysis showed that CAR could be a prognostic biomarker for HCC patients regardless of regions (China, HR = 1.75, 95% CI 1.51~2.02; Japan, HR = 3.36, 95% CI 2.07~5.45; Korea, HR = 2.26, 95% CI 1.47~4.47; respectively), the cut-off value (<0.1, HR = 2.84, 95% CI 1.90~4.24; >0.1, HR = 1.99, 95% CI 1.52~2.61; respectively), and sample size (<200, HR = 2.85, 95% CI 2.01~4.03; >200, HR = 1.75, 95% CI 1.52~2.02; respectively). Conclusion With the current data, we clearly concluded that CAR was closely correlated with prognosis of patients with HCC. Multicenter, prospective randomized trials are warranted to confirm the conclusion.
Highlights
The incidence of hepatocellular carcinoma (HCC) is increasing stably worldwide, but the prognosis still far from satisfactory [1]
202 records were identified by Jingrong Li and Nanping Lin. 9 records were excluded for duplication by NoteExpress 3.1, and 186 records were excluded after browsing titles and abstracts
The publication bias analysis was conducted for the pooled Hazard ratio (HR) for the overall survival (OS) rates comparing between low and high C-reactive protein to albumin ratio (CAR) groups, and results showed that significant publication biases were observed in the Egger’s test (P = 0:02, Figure 5), but no significant publication biases were observed in OS comparing between high and low level of CAR using the Begg’s test (P = 0:23)
Summary
The incidence of hepatocellular carcinoma (HCC) is increasing stably worldwide, but the prognosis still far from satisfactory [1]. C-reactive protein to albumin ratio (CAR) has been reported as a powerful prognostic indicator for solid tumors [7,8,9], and it has been confirmed in colorectal cancer, esophageal cancer, and nasopharyngeal cancer by several newly published meta-analysis [10,11,12]. High CAR has been reported to be correlated with poor prognosis of patients with HCC [13,14,15,16,17,18,19], but the results varied from each other. To the best of our Disease Markers knowledge, there are no meta-analysis and systematic review evaluating the prognostic value of CAR in patients with HCC. A meta-analysis was warranted to determine the prognostic significance of CAR for clinical outcomes in HCC patients
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