Abstract
High-sensitivity C-reactive protein (hsCRP) is a prognostic factor for hepatocellular carcinoma (HCC), while albumin is known to be a disease severity index of the malnutrition status in HCC patients. The present study investigated the association between postoperative hsCRP/albumin ratio and both overall survival (OS) and recurrence-free survival (RFS) following HCC surgery. This retrospective observational study examined the medical records of 389 patients who underwent resection for HCC between 2004 and 2013. Postoperative day 0–1 hsCRP/albumin ratio was collected, and the optimal postoperative mortality cut-off point was derived using receiver operating characteristics (ROC) analysis. A postoperative hsCRP/albumin ratio increase of 1.0 was associated with a 1.171-fold increase in mortality (hazard ratio (HR): 1.171, 95% confidence interval (CI): 1.072–1.278, p < 0.001) and a 1.19-fold increase in recurrence (HR: 1.190, 95% CI: 1.108–1.278, p < 0.001). The hsCRP/albumin ratio cut-off point was found to be 0.625 and 0.500. When patients were grouped by this cut-off point, the >0.625 group showed a 2.257-fold increase in mortality (HR: 2.257, 95% CI: 1.470–3.466, p < 0.001), and the >0.500 group showed a 1.518-fold increase in recurrence (HR: 1.518, 95% CI: 1.125–2.050, p = 0.006).
Highlights
Liver cancer is the second leading cause of cancer-related mortality worldwide, causing 745,000 deaths per year [1]
The results of the current study suggested that the postoperative High-sensitivity C-reactive protein (hsCRP)/albumin ratio is a prognostic marker to predict long-term oncologic outcomes after surgery for Hepatocellular carcinoma (HCC)
A cut-off point of 0.625 for mortality and 0.500 for recurrence was determined for the postoperative hsCRP/albumin ratio through an receiver operating characteristics (ROC) analysis, and the risk of both recurrence and death increased based on this cut-off point
Summary
Liver cancer is the second leading cause of cancer-related mortality worldwide, causing 745,000 deaths per year [1]. The treatment of HCC mostly follows the options presented in published treatment guidelines [3,4] and multiple treatment options, including surgery, are utilized with the aim of complete cure [5,6] Despite these multiple treatment options, the recurrence rate for HCC is approximately 70% [7], and subsequently, the overall survival (OS) and recurrence-free survival (RFS) of patients with HCC remains poor [8]. Albumin is a protein that reflects a given patient’s nutritional state and is known to be associated with postoperative mortality [11,12]. Based on these relationships, high hsCRP and low albumin levels may be associated with increased patient mortality. Previous investigations have reported that the hsCRP/albumin ratio is predictive of prognosis in patients admitted to the emergency room [13] and those with infection [14]
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