Abstract
BackgroundIn recent years, the role of pre-treatment C-reactive protein/albumin ratio (CAR) in prognosis of esophageal cancer (EC) has been investigated by several studies. This meta-analysis aimed to provide a more accurate and objective assessment of the prognostic value of pre-treatment CAR in EC.MethodsStudies assessing the role of pre-treatment CAR in prognosis of EC were searched from PubMed, Embase and the Cochrane Library (last update by April 16, 2019). The hazard ratios (HRs) of CAR and the corresponding 95% CIs for overall survival (OS) or cancer-specific survival (CSS) in EC were extracted for pooled analysis.ResultsA total of eight observational studies including 2255 patients were collected. The pooled analysis showed that high CAR was related to worse OS in EC (pooled HR = 1.81; 95% CI = 1.40–2.35; P < 0.001). Subgroup analyses showed that the negative correlation between the CAR and OS was consistently demonstrated in subgroups stratified by country, pathological type, and cut-off value (P < 0.05). However, there was no relation between CAR and OS in subgroup of patients receiving neoadjuvant chemotherapy at a proportion of 100% (HR = 1.15, 95% CI = 0.56–2.69; P = 0.715). In addition, high CAR was also related to worse CSS in EC (pooled HR = 2.61; 95% CI = 1.67–4.06; P < 0.001).ConclusionsHigh pre-treatment CAR was an adverse prognostic factor for EC patients. More large-sample clinical trials are still needed to verify the prognostic value of pre-treatment CAR in EC.
Highlights
In recent years, the role of pre-treatment C-reactive protein/albumin ratio (CAR) in prognosis of esophageal cancer (EC) has been investigated by several studies
Esophageal cancer (EC) is one of the most common malignant tumors of digestive system [1]. 62.9% of new cases of EC in the world come from China, and are mainly esophageal squamous cell carcinoma (ESCC) [2, 3]
Inclusion criteria The included studies must meet the following criteria: (1) Studies investigated the role of CAR in the prognosis of EC; (2) Serum CRP and albumin levels were obtained prior to operation and chemotherapy; (3) The hazard ratio (HR) and 95% confidence intervals (CI) for survival were reported or could be figured out
Summary
The role of pre-treatment C-reactive protein/albumin ratio (CAR) in prognosis of esophageal cancer (EC) has been investigated by several studies. This meta-analysis aimed to provide a more accurate and objective assessment of the prognostic value of pre-treatment CAR in EC. Diagnosis and correct treatment strategy based on prognostic assessment are the key to improve the prognosis of EC. CRP/Alb ratio (CAR) is an indicator that reflects both inflammatory and nutritional status. Most patients with malignant tumors have elevated CAR [6, 7]. Elevated CAR indicates an increase in serum CRP concentration and hypoalbuminemia, suggesting that the overall condition of the patient is poor [8]. Studies have shown that CAR is related to prognosis in different tumors [9,10,11]
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