Post-adjuvant chemotherapy, but not preoperative, C-reactive protein/albumin ratio is prognostic factor in stage II-III colorectal cancer patients

Abstract

Abstract Background An elevated preoperative C-reactive protein/albumin (CRP/Alb) ratio (CAR) has been reported to be associated with a poor prognosis for various cancers, including colorectal cancer (CRC). However, whether the post-adjuvant chemotherapy CAR is a valuable prognostic factor in patients with CRC is not clear. Methods A retrospective study was performed in 445 patients with CRC receiving chemotherapy after curative resection. Preoperative and post-adjuvant chemotherapy C-reactive protein/albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systematic immune-inflammation index (SII), Glasgow Prognostic Score (GPS), modified Glasgow prognositc score(mGPS) and high-sensitivity modified Glasgow prognostic score (HS-mGPS), were calculated to assess the inflammatory state of subjects. Firstly, the patients were subdivided into two groups by the CAR, NLR, PLR, SII, GPS, mGPS, and HS-mGPS level. Furthermore, subjects were stratified into four groups for each marker according to the longitudinal changes in indicators from preoperative to post-chemotherapy: low group, normalised group, high group and elevated group. The receiver operating characteristic curve analyses and the corresponding areas under the curve (AUCs) was used to compare the prognostic value of different markers. Multivariable analyses for overall survival (OS) were performed to adjust for well-established clinicopathologic factors. Kaplan-Meier and Cox regression models were used to assess independent prognostic factors. Results The post-adjuvant chemotherapy CAR, NLR, PLR and SII had a high aera under the curve value compared with preoperative scores. What’s more, the post-adjuvant chemotherapy CAR had a high aera under the curve value compared with several other systemic inflammation-based prognostic scores. Patients with high post-adjuvant chemotherapy GPS and mGPS had significantly worse OS than patients with low groups. Conclusion The post-adjuvant chemotherapy CRP/Alb ratio is a superior predictor of OS in patients undergoing curative resection for colorectal cancer and may help to identify the high-risk patients for treatment decisions.