ASO Author Reflections: The C-Reactive Protein (CRP)-Albumin Ratio May Be Useful as the Most Prognostic Index Among the
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: The C-Reactive Protein (CRP)-Albumin Ratio May Be Useful as the Most Prognostic Index Among the Immuno-nutritional Parameters Using CRP and Albumin for Resected NSCLC Taichi Matsubara, MD, PhD, and Tatsuro Okamoto, MD, PhD Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
PAST Recently, several clinical studies have shown that immune-nutritional parameters were associated with poor survival of patients with malignant tumors, including nonsmall cell lung cancer (NSCLC). Among them, the following three parameters using serum C-reactive protein (CRP) and albumin were known: the Glasgow prognostic score (GPS), the modified GPS (mGPS), and the CRP1 albumin ratio (CAR). However, it remains unclear which of these three parameters reflect postoperative prognosis most accurately. PRESENT The study enrolled 597 patients who underwent curative pulmonary resection for primary NSCLC. In this study, the clinicopathologic and prognostic significance of the GPS, mGPS, and CAR was evaluated. The positivities of GPS and mGPS were respectively 7.6 % and 12.2 %. Of the 597 patients, 480 (80.5 %) were classified in the high CAR group. In uni- and multivariate analyses, the GPS, mGPS, and CAR all were significantly associated with postoperative poor survival, and a high CAR was an independent factor that predicted poor recurrence-free survival (RFS) and overall survival (OS). In addition, survival analyses of the stage 1 subgroup were performed. Although the GPS,
Ó Society of Surgical Oncology 2020 First Received: 26 September 2020 Accepted: 4 October 2020 T. Matsubara, MD, PhD e-mail: [email protected]
mGPS, and CAR all were significantly associated with postoperative prognosis in the univariate analysis, only high CAR was an independent poor prognostic factor for 2 both RFS and OS. FUTURE Some studies have compared the prognostic significance of several immune-nutritional markers including GPS, 1,3,4 4 mGPS and CAR. Ni et al. reported that the CAR was reported as the best prognostic marker for predicting tumor recurrence and poor OS compared with other immunenutritional parameters. However, these previous reports included patients at an advanced stage of disease, which likely had a great effect on the CAR. The current study showed that the CAR had strong prognostic power, even in the stage 1 subgroup. In the future, the prognostic value of the CAR should be confirmed by analyzing another cohort or by performing a prospective study. REFERENCES 1. Yamauchi Y, Safi S, Muley T, et al. C-reactive protein-albumin ratio is an independent prognostic predictor of tumor recurrence in stage IIIA-N2 lung adenocarcinoma patients. Lung Cancer. 2017;114:62–7. 2. Matsubara T, Takamori S, Haratake N, et al. Identification of the best prognostic marker among immune-nutritional parameters using serum C-reactive protein and albumin in non-small cell lung cancer. Ann Surg Oncol. 2020. https://doi.org/10.1245/s10434-02 0-09230-x. 3. Kinoshita A, O
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