Abstract

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.

Highlights

  • In 1863, Rudolf Virchow first provided the hypothesis of a possible correlation between inflammation and malignant tumor according to the presence of leukocytes within tumors [1]

  • The hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) of these 24 studies were all directly extracted from the outcomes of multivariate analysis

  • Sensitivity analysis was conducted to evaluate the robustness of association between C-reactive protein/albumin ratio (CAR) and survival outcomes, and the results suggested that no individual study significantly changed the overall HRs of our metaanalysis for overall survival (OS) and disease-free survival (DFS) (Figure 4)

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Summary

Introduction

In 1863, Rudolf Virchow first provided the hypothesis of a possible correlation between inflammation and malignant tumor according to the presence of leukocytes within tumors [1] It is only during the last twenty years that clear evidence has been obtained that inflammation plays a decisive role in carcinogenesis and tumor progression; for example, inflammation regulates tumor behavior at different stages of tumor development, including initiation, promotion, malignant conversion, invasion, and metastasis [2]. Malnutrition can weaken a number of defense mechanisms in human body, including physiologic barrier, immune system, and phagocyte function. This problem has been proved to be correlated with increased susceptibility to infection, poor curative response, serious therapeutic side effects, and worse survival [7]. It is critical to precisely and early identify nutritional risk in cancer patients

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