Abstract
Backgrounds Both pretreatment serum CRP (C-reactive protein) level and ALB (albumin) level have been found to be predictive of survival for multiple malignancies including sarcoma. Since both of the GPS (Glasgow prognostic score) and CAR (C-reactive protein to albumin ratio) are based on the combination of CRP and ALB, we conducted a meta-analysis to evaluate the prognostic role of these two parameters for sarcoma patients. Methods A detailed literature search was conducted in MEDLINE, Embase, and Cochrane Library for relevant research publications written in English. Patients' clinical characteristics, outcomes of overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were extracted. Pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were combined to evaluate the prognostic role of GPS or CAR. Results Twelve articles containing 2695 patients were identified as eligible studies. The results showed that an elevated GPS was significantly correlated with poor OS (HR = 2.42; 95% CI: 1.98-2.94; p < 0.001; fixed-effects model), DSS (HR = 2.28; 95% CI: 1.75-2.97; p < 0.001; fixed-effects model), and DFS (HR = 2.05; 95% CI: 1.62-2.60; p < 0.001; fixed-effects model). A higher CAR also was shown to be significantly correlated with poor OS (HR = 2.23; 95% CI: 1.70-2.92; p < 0.001; fixed-effects model) and DFS (HR = 1.81; 95% CI: 1.7-2.58; p = 0.001; fixed-effects model). Conclusion An elevated GPS is predictive of poor survival in patients with sarcomas and is promising to be used as a factor for risk stratification. A higher CAR value is also predictive of poor survival; however, the optimal CAR cut-off value is still to be determined.
Highlights
Sarcoma represents a heterogeneous group of mesenchymal malignancies that arise from soft tissue or bone, with diverse subtypes and varying degrees of aggressiveness [1, 2]
The results showed that both the elevated Glasgow prognostic score (GPS) and higher CAR are significantly correlated with poor survival in sarcoma patients separately
Two thousand one hundred and sixty-five records in total were found in the initial search of the three databases, and 420 duplicate articles were deleted after duplicate checking
Summary
Sarcoma represents a heterogeneous group of mesenchymal malignancies that arise from soft tissue or bone, with diverse subtypes and varying degrees of aggressiveness [1, 2]. It accounts for nearly 21% of all paediatric solid malignancies and 1% of all adult solid malignancies [2, 3]. Traditional prognostic factors such as pathological grade, tumor size, tumor depth, or surgical margins have been used for risk stratification, but fail to accurately predict disease recurrence or survival [4]. New parameters are still needed to further improve the risk stratification of sarcoma
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