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Observational Study
. 2016 Dec 8;11(12):e0167967.
doi: 10.1371/journal.pone.0167967. eCollection 2016.

The C-Reactive Protein to Albumin Ratio as a Predictor of Severe Side Effects of Adjuvant Chemotherapy in Stage III Colorectal Cancer Patients

Tetsuro Tominaga  1 , Takashi Nonaka  1 , Yorihisa Sumida  1 , Shigekazu Hidaka  1 , Terumitsu Sawai  2 , Takeshi Nagayasu  1
Affiliations
Observational Study

The C-Reactive Protein to Albumin Ratio as a Predictor of Severe Side Effects of Adjuvant Chemotherapy in Stage III Colorectal Cancer Patients

Tetsuro Tominaga et al. PLoS One. .

Abstract

Background/aims: Adjuvant chemotherapy (AC) has been reported to improve the prognosis for patients with Stage III colorectal cancer (CRC). However, some patients experience severe side effects and must stop AC. The C-reactive protein (CRP) to albumin ratio (CAR) is a novel inflammation-based score that could reflect the patient's general condition. The aim of this study was to evaluate the predictive value of the CAR for side effects of AC in CRC.

Methods: A total of 136 CRC patients who received AC were retrospectively analyzed. The patients were subdivided into two groups by the CAR level (CAR ≥0.1, n = 30; CD < 0.1, n = 106).

Results: The presence of lymphatic invasion, severe side effects, and discontinuation of AC were associated with high CAR levels (p = 0.02, <0.01, and 0.02; respectively). High levels of the Glasgow Prognostic Score (GPS) and the neutrophil to lymphocyte ratio (NLR) appeared to be associated with the CAR (p = 0.04, p<0.01; respectively). Multivariate analysis identified CAR≥0.1 (HR: 7.06, 95% CI: 2.51-19.88, p<0.01) as a significant determinant of severe side effects of AC. CAR had the highest area under the curve (0.79) among several inflammation-based scores.

Conclusion: The present study showed that the CAR is a novel and promising inflammation-based score for ≥ grade 3 side effects of AC in node-positive CRC.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Kaplan-Meier curves of the effect of the CAR on DFS and OS.
Disease-free survival is better in the L-group than in the H-group (p = 0.03). However, there is no significant difference in overall survival between the two groups (p = 0.25) (Fig 1B). CAR, CRP to albumin ratio; OS, overall survival; DFS, disease-free survival.
Fig 2
Fig 2. Receiver operating curve analysis for severe side effects.
Areas under the curves of the CAR, GPS, PLR, and NLR are 0.79, 0.57, 0.56, and 0.49, respectively. CAR has the highest AUC level among the several inflammation-based scores. CAR, CRP to albumin ratio; NLR, neutrophil to lymphocyte ratio; GPS, Glasgow prognostic score; PLR, platelet to lymphocyte ratio.
See this image and copyright information in PMC

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