Identification of the Best Prognostic Marker Among Immunonutritional Parameters Using Serum C-Reactive Protein and Album
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ORIGINAL ARTICLE – THORACIC ONCOLOGY
Identification of the Best Prognostic Marker Among Immunonutritional Parameters Using Serum C-Reactive Protein and Albumin in Non-Small Cell Lung Cancer Taichi Matsubara, MD, PhD1, Shinkichi Takamori, MD, PhD1, Naoki Haratake, MD, PhD1, Takatoshi Fujishita, MD, PhD1, Ryo Toyozawa, MD1, Kensaku Ito, MD, PhD1, Mototsugu Shimokawa, MD, PhD2, Masafumi Yamaguchi, MD, PhD1, Takashi Seto, MD, PhD1, and Tatsuro Okamoto, MD, PhD1 1
Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan; 2Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
ABSTRACT Background. Three immune-nutritional parameters exist for malignant tumors using serum C-reactive protein (CRP) and albumin: the Glasgow prognostic score (GPS), the modified GPS (mGPS), and the CRP-albumin ratio (CAR). However, it remains unclear which of the three parameters is the most predictive of prognosis. Therefore, this study compared the clinical and prognostic significance of these parameters for non-small cell carcinoma (NSCLC). Methods. The study retrospectively enrolled 596 NSCLC patients who underwent surgical resection at the authors’ institution from January 2010 to December 2015 and investigated the clinicopathologic significance of GPS, mGPS, and CAR. The optimal cutoff value for CAR was determined by a receiver operating curve (ROC). Results. The median age of the patients was 69 years. Lymph node metastases were identified in 99 patients, and 455 patients had a diagnosis of stage 1 disease. The positivity for GPS was 7.6%, and that of mGPS (score, 1 or 2) was 12.2%. Of the 596 patients, 480 patients (80.5%) were classified in the high CAR group. In univariate survival
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09230-x) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 4 June 2020 Accepted: 19 September 2020 T. Seto, MD, PhD e-mail: [email protected]
analyses, all three parameters were associated significantly with postoperative survival. The multivariate analyses showed CAR to be an independent prognostic factor. Additionally, survival analyses of the stage 1 subgroup were performed because CAR was higher for patients with an advanced stage of disease or lymph node metastases. In these subgroup analyses, CAR also was an independent prognostic factor. Conclusion. As the most prognostic index, CAR may be useful among the immunonutritional parameters using CRP and albumin for resected NSCLC.
Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death worldwide.1 The remarkable development of multidisciplinary strategies for treatment of lung cancer, including surgery, radiotherapy, and chemotherapy, has improved outcomes for patients with non-small cell lung cancer (NSCLC). With these approaches, surgical resection is the radical treatment option for most of s
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