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The C-Reactive Protein/Albumin Ratio, a Novel Inflammation-Based Prognostic Score, Predicts Outcomes in Patients with Hepatocellular Carcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The C-reactive protein/albumin (CRP/Alb) ratio is associated with outcomes in septic patients. We investigated the prognostic value of the CRP/Alb ratio in patients with hepatocellular carcinoma (HCC).

Methods

We retrospectively evaluated 186 newly diagnosed HCC patients and investigated the correlations among the pretreatment CRP/Alb ratio, clinicopathological parameters, and overall survival (OS). Multivariate analyses were performed to identify the clinicopathological parameters associated with OS. Subsequently, we evaluated the prognostic value of the CRP/Alb ratio compared with other inflammation-based prognostic scores [Glasgow Prognostic Score (GPS), modified GPS (mGPS), and neutrophil lymphocyte ratio (NLR)] using the area under the curve (AUC).

Results

The optimal cutoff level for the CRP/Alb ratio was 0.037. An elevated CRP/Alb ratio (≥0.037) was associated with tumor progression and reduced liver functional reserve. In the multivariate analysis, the CRP/Alb ratio [hazard ratio (HR) 3.394; p < 0.0001], Cancer Liver Italian Program score (HR 2.686; 95 % CI 2.122–3.401; p < 0.0001), and vascular invasion (HR 3.376; 95 % CI 1.594–7.151; p = 0.001) were independently associated with OS (HR 3.394; p < 0.0001). The CRP/Alb ratio had higher AUC values at 6 months (0.844), 12 months (0.863), and 24 months (0.82) compared with the GPS, mGPS, and NLR.

Conclusion

The CRP/Alb ratio might be an independent prognostic marker in patients with HCC, and may have comparable prognostic ability to other established inflammation-based prognostic scores. The prognostic value of this novel inflammation-based prognostic score needs to be verified in patients with other types of cancer.

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Disclosures

Akiyoshi Kinoshita, Hiroshi Onoda, Nami Imai, Akira Iwaku, Mutumi Oishi, Ken Tanaka, Nao Fushiya, Kazuhiko Koike, Hirokazu Nishino, and Masato Matsushima declare no conflicts of interest.

Financial Disclosures

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, The Jikei University Daisan Hospital, Komae-Shi, Tokyo, Japan

    Akiyoshi Kinoshita MD, Hiroshi Onoda MD, Nami Imai MD, Akira Iwaku MD, Mutumi Oishi MD, Ken Tanaka MD, Nao Fushiya MD, Kazuhiko Koike MD & Hirokazu Nishino MD

  2. Division of Clinical Epidemiology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan

    Masato Matsushima MD

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  1. Akiyoshi Kinoshita MD
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  2. Hiroshi Onoda MD
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Correspondence to Akiyoshi Kinoshita MD.

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Kinoshita, A., Onoda, H., Imai, N. et al. The C-Reactive Protein/Albumin Ratio, a Novel Inflammation-Based Prognostic Score, Predicts Outcomes in Patients with Hepatocellular Carcinoma. Ann Surg Oncol 22, 803–810 (2015). https://doi.org/10.1245/s10434-014-4048-0

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  • DOI: https://doi.org/10.1245/s10434-014-4048-0

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