Preoperative C-reactive protein-to-albumin ratio and clinical outcomes after resection of colorectal liver metastases
Preoperative C-reactive protein-to-albumin ratio and clinical outcomes after resection of colorectal liver metastases
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DOI：
10.1016/j.suronc.2020.09.014
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发表时间：
2020-12-01
影响因子：
2.3
通讯作者：
Baba, Hideo
中科院分区：
文献类型：
--
作者：
Sakamoto, Yuki;Mima, Kosuke;Baba, Hideo
目的：越来越多的证据表明炎性肿瘤微环境可以促进肿瘤的进展和转移。C反应蛋白/白蛋白比率(CAR)是一种新的基于炎症的预后评分。本研究旨在探讨结直肠肝转移瘤(CRLM)根治性切除患者术前CAR与临床预后的关系。方法：回顾分析2001年11月至2018年1月在日本熊本大学接受CRLM根治性切除的184例患者的术前CAR。通过生存分类和回归树(CART)分析，确定CAR术前的最佳截断点。我们比较了高CAR组和低CAR组的临床病理因素和预后。用COX比例风险模型计算危险比(HR)，控制潜在的混杂因素。结果：术前CAR越高，总体生存率(OS)(p<；0.0001)和复发生存率(RF)越差(p=0.003)。应用生存CART分析，高CAR组33例(17.9%)。在多因素分析中，高CAR与较短的OS(HR，2.82；95%可信区间，1.63-4.72；p=0.0004)和RFS(HR，1.62；95%可信区间，1.02-2.49；p=0.040)独立相关。CAR值高与肿瘤体积大、血清癌胚抗原和糖类抗原19-9水平高、术中出血量多、术后并发症多有关。结论：术前高CAR值与较短的OS和RFS有关，可作为判断根治性切除后CRLM患者预后的指标。
Purpose: Accumulating evidence suggests that the inflammatory tumor microenvironment can potentiate tumor progression and metastasis. The C-reactive protein-to-albumin ratio (CAR) is a novel inflammation-based prognostic score. This study was performed to examine the associations of the preoperative CAR with clinical outcomes in patients with colorectal liver metastases (CRLM) after curative resection.Methods: We retrospectively assessed the preoperative CAR in 184 patients who underwent curative resection for CRLM from November 2001 to January 2018 at Kumamoto University (Kumamoto, Japan). The optimal cutoff level of the preoperative CAR was determined by survival classification and regression tree (CART) analysis. We compared clinicopathological factors and prognoses between the high-CAR and low-CAR groups. A Cox proportional hazards model was used to calculate hazard ratios (HRs), controlling for potential confounders.Results: A higher preoperative CAR was associated with worse overall survival (OS) (p < 0.0001) and recurrencefree survival (RFS) (p = 0.003). Applying survival CART analysis, the high-CAR group comprised 33 patients (17.9%). In the multivariate analyses, a high CAR was independently associated with shorter OS (HR, 2.82; 95% confidence interval, 1.63-4.72; p = 0.0004) and RFS (HR, 1.62; 95% confidence interval, 1.02-2.49; p = 0.040). A high CAR was associated with a large tumor size, high serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels, high intraoperative blood loss, and more postoperative complications.Conclusion: A high preoperative CAR is associated with shorter OS and RFS and might serve as a prognostic marker for patients with CRLM after curative resection.