High C-reactive protein/albumin ratio predicts unfavorable distant metastasis-free survival in nasopharyngeal carcinoma: a propensity score-matched analysis
Received 30 October 2017
Accepted for publication 22 December 2017
Published 21 February 2018 Volume 2018:10 Pages 371—381
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Justinn Cochran
Peer reviewer comments 2
Editor who approved publication: Professor Nakshatri
Yan Wang,1–3,* Lin Yang,1–3,* Liangping Xia,1–3 Yong Chen1–3
1Department of VIP, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China; 2State Key Laboratory of Oncology in Southern China, Guangzhou, People’s Republic of China; 3Collaborative Innovation Center for Cancer Medicine, Guangzhou, People’s Republic of China
*These authors contributed equally to this work
Background: Recent studies have indicated that the C-reactive protein/albumin (CRP/ALB) ratio (CAR) may represent a simple inflammation-based index for assessing the host inflammatory response. In this study, the prognostic value of the CAR for distant metastasis-free survival (DMFS) in nasopharyngeal carcinoma (NPC) was assessed.
Methods: A total of 1,168 non-metastatic NPC patients from Sun Yat-sen University Cancer Center were retrospectively included. The optimal cutoff value for CAR was defined by the Cutoff Finder online tool. Propensity case-matched analysis was performed to adjust for potential differences in baseline characteristics. Subsequently, the prognostic value of the CAR for DMFS was validated in a 756 validation cohort with NPC.
Results: The optimal CAR cutoff value was 0.081. Patients with high CAR values had significantly poorer DMFS than those with low CAR in univariate and multivariate analyses before propensity score matching. The CAR could also significantly stratify patients into different risks of developing distant metastasis in subgroup analysis. Propensity score analyses showed that CAR remained a prognostic factor for DMFS, thus excluding other interpretations and selection bias. Moreover, the prognostic value of the CAR was robustly confirmed in the external validation cohort.
Conclusion: CAR is an inexpensive and easy-to-measure inflammatory index that may aid clinicians in the development of individualized treatment and follow-up strategies for patients with non-metastatic NPC.
Keywords: nasopharyngeal carcinoma, metastasis, prognosis, propensity score, C-reactive protein, albumin
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