| 【Objective】Urologic neoplasm is one of the common human tumors,which seriously threatens human health.Until now,only a few serological indicators have been used to predict the long-term prognosis.Recently,several studies have reported that the C-reactive protein to albumin ratio(CAR)can effectively predict the long-term outcome of urologic neoplasm.However,most of them included a small number of cases and a weak level of evidence.This study aimed to systematically evaluate the value of CAR in predicting the long-term prognosis of urologic neoplasm.【Methods】This study was conducted with the PICOS principles and the Cochrane library’s handbook.Databases such as Pubmed,Embase,Medline,Cochrane Library,sino Med,CNKI and Wanfang were searched systematically up to Dec.31 st 2019.Studies that assessed the value of CAR in predicting the long-term prognosis of urologic neoplasm were included.Hazard ratio(HR)and 95% confidence interval(CI)were used to evaluate long-term prognosis.The Odds ratio(OR)and 95% CI were used to evaluate the enumerable factor.Mean difference(MD)and 95% CI were used to evaluate the measurable factor.Review Manage5.3 was used to quantitative synthesis analysis in this study.【Results】This study included a total of 10 retrospective studies.A total of 2628 cases were included,including 1061 in the high CAR level group and 1567 in the low CAR level group.Results showed that,compared to the low CAR group,the high CAR group had a worse overall survival and disease-free survival(HR=2.60,95%CI(1.97-3.44),P<0.001;HR=2.28,95%CI(1.64-3.15),P<0.001;respectively).Subgroup analysis showed that no matter which kind of neoplasm(renal cell carcinoma,bladder carcinoma or prostatic carcinoma: HR=2.40,95%CI(1.69-3.40),P<0.001;HR=3.82,95%CI(2.13-6.83),P<0.001;HR=2.15,95%CI(1.33-3.48),P<0.001;respectively),what treatment was adopted(surgical or comprehensive treatment: HR=2.64,95%CI(1.66-4.17),P<0.001;HR=1.83,95%CI(1.41-2.37),P<0.001;respectively),or from different regions(China or Japan: HR=3.26,95%CI(2.38-4.46),P<0.001;HR=2.00,95%CI(1.63-2.47),P<0.001;respectively),the long-term outcome of the high CAR group was worse than the low one.Further analysis show that advanced T,N and M stage were more common in the group with high CAR level(OR=3.63,95%CI(1.88-6.99),P<0.001;OR=4.19,95%CI(2.94-5.97),P<0.001,OR=5.45,95%CI(2.59-11.45),P<0.001;respectively).Same results were found in higher Fuhrman stage(OR=3.86,95%CI(2.58-5.78),P<0.001),larger tumors(MD=2.22,95%CI(1.84-2.60),P<0.001),higher thrombogenesis rate(OR=8.02,95%CI(3.31-19.39),P<0.001)and Tumor necrosis rate(OR=2.31,95%CI(1.26-4.24),P=0.007).【Conclusion】This study showed that the CAR level is closely related to the long-term prognosis of urologic neoplasm.The long-term prognosis of the low CAR level group is significantly better than the high CAR level group,and it is consistent with tumor stage and tumor behavior characteristics.Therefore,it can be used as a reliable serological indicator to evaluate the long-term prognosis of urologic neoplasm and the risk of recurrence after surgery. |
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