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C-reactive protein/albumin ratio predicts survival after curative surgery in elderly patients with colorectal cancer

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Abstract

Inflammation-based markers, including the C-reactive protein/albumin ratio (CAR), lymphocyte/monocyte ratio (LMR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), Onodera’s prognostic nutritional index (PNI), and Glasgow Prognostic Score (GPS), have been demonstrated to serve as prognostic indicators in various malignancies. This study aimed to evaluate their potential predictive value for colorectal cancer (CRC) in the elderly. We retrospectively evaluated 163 patients with CRC, aged 80 years and older, who had undergone curative surgery. The receiver operating characteristic curve analyses and the corresponding areas under the curve (AUCs) were used to determine and compare the discriminatory ability of the inflammation-based markers. Besides, the associations of inflammatory markers and clinical characteristics with overall survival (OS), relapse-free survival (RFS), and cancer-specific survival (CSS) were analyzed. The CAR had a significantly larger AUC than the GPS, PLR, NLR, and LMR (p = 0.006, 0.012, 0.018, and 0.002, respectively), except for the PNI (p = 0.052). The optimal cut-off value was 0.106 for the CAR and 44.894 for the PNI. Moreover, a CAR ≥ 0.106 turned out to be significantly associated with worse 5-year OS, RFS, and CSS compared with a CAR < 0.106. The multivariate analysis indicated that the CAR ≥ 0.106 was an independent prognostic factor for poor OS (HR = 3.596, p = 0.0006), RFS (HR = 2.945, p = 0.003), and CSS (HR = 4.411, p = 0.02). CAR is a useful and promising prognostic marker in elderly patients undergoing curative surgery for CRC.

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The datasets analysed during the current study are available from the corresponding author on reasonable request.

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Funding

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Contributions

Material preparation, data collection were performed by KT, SM, YK, and SH. Analysis were performed by KT and SO. The first draft of the manuscript was written by KT and SO and all authors commented on previous version of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Shu Okamura.

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This study was performed in line with the principles of the Declaration of Helsinki. The study was approved by the Ethics Committee of Suita Municipal hospital (Approval number: 2020-ken15).

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The study was performed in accordance with the Helsinki declaration (64th version, 2013) and with ethical standards of institutional and/or national research committee.

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Informed consent was obtained from all individual participants included in the study.

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Tamai, K., Okamura, S., Makino, S. et al. C-reactive protein/albumin ratio predicts survival after curative surgery in elderly patients with colorectal cancer. Updates Surg 74, 153–162 (2022). https://doi.org/10.1007/s13304-021-01011-9

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