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. 2020 Oct 22;10(11):859.
doi: 10.3390/diagnostics10110859.

Clinical Impact of Combined Modified Glasgow Prognostic Score and C-Reactive Protein/Albumin Ratio in Patients with Colorectal Cancer

Woosung Son  1 , Su-Jin Shin  2 , Su Hyeong Park  1 , Soo Kyung Lee  1 , Eun Jung Park  1 , Seung Hyuk Baik  1 , Kang Young Lee  3 , Jeonghyun Kang  1
Affiliations

Clinical Impact of Combined Modified Glasgow Prognostic Score and C-Reactive Protein/Albumin Ratio in Patients with Colorectal Cancer

Woosung Son et al. Diagnostics (Basel). .

Abstract

The prognostic impact of the combination of the modified Glasgow prognostic score (mGPS) and C-reactive protein/albumin ratio (CAR) in colorectal cancer (CRC) is unclear. We aimed to investigate the clinical usefulness of this combination as a predictor of survival in CRC patients. We retrospectively evaluated 769 CRC patients who had undergone surgery between January 2006 and March 2014. The CAR and mGPS within 1 month postoperation were examined. The integrated area under the curve (iAUC) was compared among mGPS, CAR, and the combined classification (CC). The optimal CAR cut-off for discriminating overall survival was 0.14. Based on this cut-off, the mGPS 0 group was divided into the mGPS 0 with low CAR and the mGPS 0 with high CAR groups, whereas all mGPS 1 and 2 patients were classified into the high CAR group. CC was an independent prognostic factor, and its iAUC value (0.587, 95% CI 0.553-0.624) was superior to those of the mGPS (0.544, 95% CI 0.516-0.576) (bootstrap iAUC mean difference = 0.043; 95% CI = 0.015-0.072) and CAR (0.578, 95% CI 0.545-0.613) (bootstrap iAUC mean difference = 0.009; 95% CI = 0.002-0.017), respectively. In conclusion, the combination of mGPS and CAR has a synergistic effect and has a higher prognostic accuracy than mGPS or CAR alone in patients with CRC.

Keywords: C-reactive protein/albumin ratio; colorectal cancer; integrated area under the curve; modified glasgow prognostic score; survival.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of patients. CRP: C-reactive protein, FAP: Familial adenomatous polyposis, and HNPCC: Hereditary nonpolyposis colorectal cancer.
Figure 2
Figure 2
Determining the cut-off value of the CAR using the X-tile program. The variable color points in the X-tile plots represent associated strength at each split from low (dark, black) to high (bright, red, or green). Red indicates an inverse association between the expression levels and survival of the variables, while green indicates a direct association. We defined optimal cut-off value as the value that produced the largest χ2 in the Mantel–Cox test, which was set as 0.14.
Figure 3
Figure 3
Kaplan–Meier curves of overall survival according to the mGPS, CAR, and combination classification.
Figure 3
Figure 3
Kaplan–Meier curves of overall survival according to the mGPS, CAR, and combination classification.
Figure 4
Figure 4
Time-dependent receiver operating characteristic (ROC) among the mGPS, CAR, and CC.
Figure 5
Figure 5
Comparison of integrated AUC among the mGPS, CAR, and CC.
See this image and copyright information in PMC

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