The association between C-reactive protein/albumin ratio and prognosis of lung cancer patients: a meta-analysis_West China Medical Journal

Authors：

WANG Yan ¹ , WU Yanming ¹ , WANG Yanwen ² , XU Wenying ² ,  CHE Guowei ¹

1. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CHE Guowei, Email: hx_guowei_che@foxmail.com

Keywords：

Lung cancer; C-reactive protein/albumin ratio; Prognosis; Meta-analysis

DOI：

10.7507/1002-0179.201812086

Video：

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ObjectiveTo explore the association between C-reactive protein/albumin ratio (CAR) and prognosis of lung cancer patients.MethodsWe searched PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang and Chongqing VIP databases for eligible studies evaluating the predictive role of CAR for the prognosis in lung cancer from establishment of databases to November 30, 2018. The Stata 12.0 software was used to conduct the meta-analysis and the pooled hazard ratio (HR) was used to assess the association between CAR and prognosis of lung cancer.ResultsA total of 1 903 lung cancer patients from 6 retrospective studies were included in the current meta-analysis and all the patients were from Asian countries. The results showed that patients with elevated pretreatment CAR were significantly correlated with worse overall survival [HR=1.75, 95% confidence interval (1.53, 1.99), P<0.001] with low heterogeneity (I²=25.9%, P=0.240). Subgroup analyses based on the country, pathology and treatment further demonstrated above findings.ConclusionsElevated pretreatment CAR is a negative predictor for prognosis in Asian patients with lung cancer. More researches with big sample size and high quality from non-Asian countries are still needed to verify our results.

Citation： WANG Yan, WU Yanming, WANG Yanwen, XU Wenying, CHE Guowei. The association between C-reactive protein/albumin ratio and prognosis of lung cancer patients: a meta-analysis. West China Medical Journal, 2019, 34(1): 50-57. doi: 10.7507/1002-0179.201812086 Copy

1.	Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin, 2013, 63(1): 11-30.
2.	Dela Cruz CS, Tanoue LT, Matthay RA. Lung cancer: epidemiology, etiology, and prevention. Clin Chest Med, 2011, 32(4): 605-644.
3.	Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2): 69-90.
4.	Fan H, Shao ZY, Xiao YY, et al. Incidence and survival of non-small cell lung cancer in Shanghai: a population-based cohort study. BMJ Open, 2015, 5(12): e009419.
5.	Tas F, Ciftci R, Kilic L, et al. Age is a prognostic factor affecting survival in lung cancer patients. Oncol Lett, 2013, 6(5): 1507-1513.
6.	Wainer Z, Wright GM, Gough K, et al. Impact of sex on prognostic host factors in surgical patients with lung cancer. ANZ J Surg, 2017, 87(12): 1015-1020.
7.	Yoshino I, Maehara Y. Impact of smoking status on the biological behavior of lung cancer. Surg Today, 2007, 37(9): 725-734.
8.	石亚飞, 陈伟, 曹宇, 等. 非小细胞肺癌患者预后影响因素分析及预测列线图构建. 中国医院药学杂志, 2018, 38(20): 2137-2141.
9.	Yoon HM, Ryu KW, Nam BH, et al. Is the new seventh AJCC/UICC staging system appropriate for patients with gastric cancer?. J Am Coll Surg, 2012, 214(1): 88-96.
10.	Dutta S, Crumley AB, Fullarton GM, et al. Comparison of the prognostic value of tumour- and patient-related factors in patients undergoing potentially curative resection of oesophageal cancer. World J Surg, 2011, 35(8): 1861-1866.
11.	Feng JF, Chen QX. Significance of the prognostic nutritional index in patients with esophageal squamous cell carcinoma. Ther Clin Risk Manag, 2014, 10: 1-7.
12.	McMillan DC. The systemic inflammation-based Glasgow Prognostic Score: a decade of experience in patients with cancer. Cancer Treat Rev, 2013, 39(5): 534-540.
13.	Huang Y, Feng JF, Liu JS, et al. Prognostic role of serum C-reactive protein in esophageal cancer: a systematic review and meta-analysis. Ther Clin Risk Manag, 2015, 11(11): 89-94.
14.	Zhang P, Xi M, Zhao L, et al. Comparison of two inflammation-based prognostic scores in patients with thoracic esophageal cancer undergoing chemoradiotherapy. Int J Clin Exp Med, 2016, 9(2): 1764-1771.
15.	Zhou T, Zhan J, Hong S, et al. Ratio of C-reactive protein/albumin is an inflammatory prognostic score for predicting overall survival of patients with small-cell lung cancer. Sci Rep, 2015, 5: 10481.
16.	Miyazaki T, Yamasaki N, Tsuchiya TA, et al. Ratio of C-reactive protein to albumin is a prognostic factor for operable non-small-cell lung cancer in elderly patients. Surg Today, 2017, 47(7): 836-843.
17.	Zhang FR, Ying LS, Jin JY, et al. The C-reactive protein/albumin ratio predicts long-term outcomes of patients with operable non-small cell lung cancer. Oncotarget, 2017, 8(5): 8835-8842.
18.	Ni XF, Wu J, Ji M, et al. Effect of C-reactive protein/albumin ratio on prognosis in advanced non-small-cell lung cancer. Asia Pac J Clin Oncol, 2018, 14(6): 402-409.
19.	Koh YW, Lee HW. Prognostic impact of C-reactive protein/albumin ratio on the overall survival of patients with advanced nonsmall cell lung cancers receiving palliative chemotherapy. Medicine (Baltimore), 2017, 96(19): e6848.
20.	Jin J, Liu D, Zhou YZ, et al. C-reactive protein to albumin ratio as prognostic factors in lung cancer. Int J Clin Exp Med, 2017, 10(12): 16780-16787.
21.	Wells G, Shea BJ, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Appl Eng Agric, 2014, 18(6): 727-734.
22.	Wang J, Sheng Z, Yang W, et al. Elevated serum concentration of chitinase 3-like 1 is an independent prognostic biomarker for poor survival in lung cancer patients. Cell Physiol Biochem, 2016, 38(2): 461-468.
23.	Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics, 1994, 50(4): 1088-1101.
24.	Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(719): 629-634.
25.	Diakos CI, Charles KA, Mcmillan DC. Cancer-related inflammation and treatment effectiveness. Lancet Oncol, 2014, 15(11): E493-E503.
26.	Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell, 2011, 144(5): 646-674.
27.	Grivennikov SI, Greten FR, Karin M, et al. Immunity, inflammation, and cancer. Cell, 2010, 140(6): 883-899.
28.	Germano G, Allavena P, Mantovani A. Cytokines as a key component of cancer-related inflammation. Cytokine, 2008, 43(3): 374-379.
29.	Grivennikov SI, Karin M. Inflammation and oncogenesis: a vicious connection. Curr Opin Genet Dev, 2010, 20(1): 65-71.
30.	Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest, 2003, 111(12): 1805-1812.
31.	Caraceni P, Tufoni M, Bonavita ME. Clinical use of albumin. Blood Transfus, 2013, 11(Suppl 4): s18-s25.
32.	Castell JV, Gómez-Lechón MJ, David M, et al. Acute-phase response of human hepatocytes: regulation of acute-phase protein synthesis by interleukin-6. Hepatology, 1990, 12(5): 1179-1186.
33.	Ataseven B, du Bois A, Reinthaller A, et al. Pre-operative serum albumin is associated with post-operative complication rate and overall survival in patients with epithelial ovarian cancer undergoing cytoreductive surgery. Gynecol Oncol, 2015, 138(3): 560-565.
34.	Chiang JM, Chang CJ, Jiang SF, et al. Pre-operative serum albumin level substantially predicts post-operative morbidity and mortality among patients with colorectal cancer who undergo elective colectomy. Eur J Cancer Care (Engl), 2017, 26(2). https://onlinelibrary.wiley.com/doi/full/10.1111/ecc.12403.
35.	Seebacher V, Grimm C, Reinthaller A, et al. The value of serum albumin as a novel Independent marker for prognosis in patients with endometrial cancer. Eur J Obstet Gynecol Reprod Biol, 2013, 171(1): 101-106.
36.	Miyoshi T, Misumi N, Hiraike M, et al. Risk factors associated with cisplatin-induced nephrotoxicity in patients with advanced lung cancer. Biol Pharm Bull, 2016, 39(12): 2009-2014.
37.	Zhao XP, Xu Z, Li HS. NSAIDs use and reduced metastasis in cancer patients: results from a meta-analysis. Sci Rep, 2017, 7(1): 1875.

1. Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin, 2013, 63(1): 11-30.
2. Dela Cruz CS, Tanoue LT, Matthay RA. Lung cancer: epidemiology, etiology, and prevention. Clin Chest Med, 2011, 32(4): 605-644.
3. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2): 69-90.
4. Fan H, Shao ZY, Xiao YY, et al. Incidence and survival of non-small cell lung cancer in Shanghai: a population-based cohort study. BMJ Open, 2015, 5(12): e009419.
5. Tas F, Ciftci R, Kilic L, et al. Age is a prognostic factor affecting survival in lung cancer patients. Oncol Lett, 2013, 6(5): 1507-1513.
6. Wainer Z, Wright GM, Gough K, et al. Impact of sex on prognostic host factors in surgical patients with lung cancer. ANZ J Surg, 2017, 87(12): 1015-1020.
7. Yoshino I, Maehara Y. Impact of smoking status on the biological behavior of lung cancer. Surg Today, 2007, 37(9): 725-734.
8. 石亚飞, 陈伟, 曹宇, 等. 非小细胞肺癌患者预后影响因素分析及预测列线图构建. 中国医院药学杂志, 2018, 38(20): 2137-2141.
9. Yoon HM, Ryu KW, Nam BH, et al. Is the new seventh AJCC/UICC staging system appropriate for patients with gastric cancer?. J Am Coll Surg, 2012, 214(1): 88-96.
10. Dutta S, Crumley AB, Fullarton GM, et al. Comparison of the prognostic value of tumour- and patient-related factors in patients undergoing potentially curative resection of oesophageal cancer. World J Surg, 2011, 35(8): 1861-1866.
11. Feng JF, Chen QX. Significance of the prognostic nutritional index in patients with esophageal squamous cell carcinoma. Ther Clin Risk Manag, 2014, 10: 1-7.
12. McMillan DC. The systemic inflammation-based Glasgow Prognostic Score: a decade of experience in patients with cancer. Cancer Treat Rev, 2013, 39(5): 534-540.
13. Huang Y, Feng JF, Liu JS, et al. Prognostic role of serum C-reactive protein in esophageal cancer: a systematic review and meta-analysis. Ther Clin Risk Manag, 2015, 11(11): 89-94.
14. Zhang P, Xi M, Zhao L, et al. Comparison of two inflammation-based prognostic scores in patients with thoracic esophageal cancer undergoing chemoradiotherapy. Int J Clin Exp Med, 2016, 9(2): 1764-1771.
15. Zhou T, Zhan J, Hong S, et al. Ratio of C-reactive protein/albumin is an inflammatory prognostic score for predicting overall survival of patients with small-cell lung cancer. Sci Rep, 2015, 5: 10481.
16. Miyazaki T, Yamasaki N, Tsuchiya TA, et al. Ratio of C-reactive protein to albumin is a prognostic factor for operable non-small-cell lung cancer in elderly patients. Surg Today, 2017, 47(7): 836-843.
17. Zhang FR, Ying LS, Jin JY, et al. The C-reactive protein/albumin ratio predicts long-term outcomes of patients with operable non-small cell lung cancer. Oncotarget, 2017, 8(5): 8835-8842.
18. Ni XF, Wu J, Ji M, et al. Effect of C-reactive protein/albumin ratio on prognosis in advanced non-small-cell lung cancer. Asia Pac J Clin Oncol, 2018, 14(6): 402-409.
19. Koh YW, Lee HW. Prognostic impact of C-reactive protein/albumin ratio on the overall survival of patients with advanced nonsmall cell lung cancers receiving palliative chemotherapy. Medicine (Baltimore), 2017, 96(19): e6848.
20. Jin J, Liu D, Zhou YZ, et al. C-reactive protein to albumin ratio as prognostic factors in lung cancer. Int J Clin Exp Med, 2017, 10(12): 16780-16787.
21. Wells G, Shea BJ, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Appl Eng Agric, 2014, 18(6): 727-734.
22. Wang J, Sheng Z, Yang W, et al. Elevated serum concentration of chitinase 3-like 1 is an independent prognostic biomarker for poor survival in lung cancer patients. Cell Physiol Biochem, 2016, 38(2): 461-468.
23. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics, 1994, 50(4): 1088-1101.
24. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(719): 629-634.
25. Diakos CI, Charles KA, Mcmillan DC. Cancer-related inflammation and treatment effectiveness. Lancet Oncol, 2014, 15(11): E493-E503.
26. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell, 2011, 144(5): 646-674.
27. Grivennikov SI, Greten FR, Karin M, et al. Immunity, inflammation, and cancer. Cell, 2010, 140(6): 883-899.
28. Germano G, Allavena P, Mantovani A. Cytokines as a key component of cancer-related inflammation. Cytokine, 2008, 43(3): 374-379.
29. Grivennikov SI, Karin M. Inflammation and oncogenesis: a vicious connection. Curr Opin Genet Dev, 2010, 20(1): 65-71.
30. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest, 2003, 111(12): 1805-1812.
31. Caraceni P, Tufoni M, Bonavita ME. Clinical use of albumin. Blood Transfus, 2013, 11(Suppl 4): s18-s25.
32. Castell JV, Gómez-Lechón MJ, David M, et al. Acute-phase response of human hepatocytes: regulation of acute-phase protein synthesis by interleukin-6. Hepatology, 1990, 12(5): 1179-1186.
33. Ataseven B, du Bois A, Reinthaller A, et al. Pre-operative serum albumin is associated with post-operative complication rate and overall survival in patients with epithelial ovarian cancer undergoing cytoreductive surgery. Gynecol Oncol, 2015, 138(3): 560-565.
34. Chiang JM, Chang CJ, Jiang SF, et al. Pre-operative serum albumin level substantially predicts post-operative morbidity and mortality among patients with colorectal cancer who undergo elective colectomy. Eur J Cancer Care (Engl), 2017, 26(2). https://onlinelibrary.wiley.com/doi/full/10.1111/ecc.12403.
35. Seebacher V, Grimm C, Reinthaller A, et al. The value of serum albumin as a novel Independent marker for prognosis in patients with endometrial cancer. Eur J Obstet Gynecol Reprod Biol, 2013, 171(1): 101-106.
36. Miyoshi T, Misumi N, Hiraike M, et al. Risk factors associated with cisplatin-induced nephrotoxicity in patients with advanced lung cancer. Biol Pharm Bull, 2016, 39(12): 2009-2014.
37. Zhao XP, Xu Z, Li HS. NSAIDs use and reduced metastasis in cancer patients: results from a meta-analysis. Sci Rep, 2017, 7(1): 1875.

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The association between C-reactive protein/albumin ratio and prognosis of lung cancer patients: a meta-analysis

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