The prognostic value of the C-reactive protein to albumin ratio in cancer: An updated meta-analysis

Abstract

Background: Previous studies have demonstrated that the C-reactive protein to albumin ratio (CAR) is correlated with the clinical outcomes of solid tumors. However, the available data have not been systematically evaluated. The objective of the present meta-analysis was to explore the prognostic value of the CAR in solid tumors.

Methods: Eligible studies were identified from the PubMed, EMBASE and Web of Science electronic databases. The clinical characteristics, disease -free survival (DFS) /progression-free survival (PFS) and overall survival (OS) were extracted from the eligible studies. The pooled hazard ratios (HRs) and 95% confidence intervals were calculated with STATA 12.0 software. We also performed subgroup, meta-regression and sensitivity analyses.

Results: In total, twenty-seven eligible studies including 10556 patients were enrolled in the present meta-analysis. The pooled HRs with 95% confidence intervals showed that the CAR was significantly associated with poor OS (HR = 1.95, 95% CI: 1.71-2.22) and DFS/PFS (HR = 1.82, 95% CI: 1.61-2.07) in patients with solid tumors. Although publication bias was found in the studies with regard to OS, a further trim and fill analysis revealed that the adjusted HR was 1.82 (95% CI: 1.69-1.96), which was close to the original HR. Subgroup analysis confirmed the CAR as a strong prognostic marker in patients with solid tumors, regardless of the tumor type, detection time, cut-off value, sample size and area.

Conclusion: Our meta-analysis indicated that a high CAR might be an unfavorable prognostic marker for OS and DFS/PFS in patients with solid tumors.

Figure 1

The flow chart of the study selection process in this meta-analysis.

Figure 2

Forest plots of pooled HR of the relationship between a high CAR and OS. CAR = C-reactive protein to albumin ratio, OS=overall survival.

Figure 3

Forest plots of pooled HR of the relationship between a high CAR and DFS/PFS. CAR=C-reactive protein to albumin ratio, DFS=disease -free survival, PFS=progression-free survival.

Figure 4

Funnel plots of publication bias of the relationship between a high CAR and OS and DFS/PFS. CAR=C-reactive protein to albumin ratio, DFS=disease -free survival, OS=overall survival, PFS=progression-free survival.

Figure 5

Funnel plots of trim and fill analysis of the relationship between a high CAR and OS. CAR = C-reactive protein to albumin ratio, OS=overall survival.

Figure 6

Sensitivity analysis of the relationship between a high CAR and OS. CAR = C-reactive protein to albumin ratio, OS=overall survival.

Figure 7

Sensitivity analysis of the relationship between a high CAR and DFS/PFS. CAR=C-reactive protein to albumin ratio, DFS=disease -free survival, PFS=progression-free survival.