Prognostic Value Of C-reactive Protein To Albumin Ratio In Stage Ⅳ Colorectal Cancer

Background and ObjectColorectal cancer is one of the most common cancers.It often has distal metastasis at the time of initial treatment with a poor prognosis and a short survival.As we all know,inflammation is closely related to the occurrence and development of malignant tumors,and the two promote each other.Many studies have used two simple and inexpensive scoring system to monitor systemic inflammatory response.One is from inflammatory cell counts and one is from protein measurement.They both have been shown to influence the prognosis of colorectal cancer.However,most studies have used inflammatory markers to monitor postoperative recurrence of early and middle colorectal cancer,while few studies have used inflammatory markers to evaluate prognosis of metastatic colorectal cancer,which is controversial.Currently,it is unclear whether the C-reactive protein to albumin ratio(CAR)affects survival in patients with metastatic colorectal cancer.This study explored the prognostic value of pre-treatment C-reactive protein to albumin ratio in patients with stage IV colorectal cancer.MethodsBy referring to the data of the follow-up room of the Cancer Hospital of Shantou University Medical College and telephone follow-up,this study retrospectively analyzed the data from January 2008 to May 2019.A total of 110 patients with stage IV colorectal cancer who were initially treated in our hospital or had recurrence after treatment were included.All the patients had complete clinical data.The last follow-up time was up to March 2021.the cut-off value of Creactive protein to albumin ratio(CAR)was obtained by using ROC curve.Patients were divided into high-CAR group(CAR< cut-off value)and low-CAR group(CAR>= cut-off value)according to the result of CAR cut-off value.The Chi-square test was used to analyze the relationship between CAR groups and patients’ general clinical characteristics.In this study,SPSS 21.0software was used for statistical analysis.In this study,Kaplan-Meier test was used to perform survival analysis and obtain survival curves.Prognostic factors were screened out according to long-rank test,and then included in Cox regression model for multivariate analysis.The efficacy of chemotherapy in this study was evaluated uniformly using RECIST 1.1 criteria.P value less than 0.05 was considered statistically significant.Results1.Relationship between CAR groups and general clinical characteristics in patients.In the study,there were 41 cases in the high-CAR group and 69 cases in the low-CAR group.According to the Chi-square test,CAR level had no statistical differences with gender,age,primary metastasis or recurrent metastasis,site of primary lesion,resection of primary lesion,combination with or not with targeted therapy in the whole treatment,number of distant metastases,CEA,and CA199.2.Relationship between CAR groups and chemotherapy efficacy.In this study,there were 15 cases of PR,45 cases of SD,9 cases of PD in the low-CAR group,and 18 cases of PR,19 case of SD,4 cases of PD in the high-CAR group.The Chi-square test showed no statistical difference between the two groups.3.Effect of CAR groups on survival time of metastatic colorectal cancer.Median survival time was 31 months in the low-CAR group and 13 months in the high-CAR group.There was a statistical difference in overall survival time between the two groups.The 1-year,2-year,and 3-year survival rates were 84.06%,55.07% and 24.64% in the low-CAR group.The 1-year,2-year,and 3-year survival rates were 53.66%,21.95% and 7.32% in the high-CAR group.The general clinical factors were included in univariate analysis including gender,age,primary or recurrent metastasis,primary tumor site,primary tumor resection,combination with or not with targeted therapy in the whole treatment,the number of distant metastatic organs,CEA,CA199,CAR level.It was found that the primary tumor site,primary tumor resection,the number of distant metastatic organs,CA199 and CAR level were all risk factors affecting the prognosis of metastatic colorectal cancer.The prognostic factors screened out by univariate analysis were analyzed by Cox regression model.The primary tumor site,primary tumor resection,the number of distant metastatic organs,CA199 and CAR levels were all independent prognostic factors.Conclusion1.The pre-treatment C-reactive protein to albumin ratio can predict the prognostic value of metastatic colorectal cancer.2.The primary tumor site,the number of distant metastatic organs,primary tumor resection,CA199 level and C-reactive protein to albumin ratio are independent risk factors affecting prognosis of metastatic colorectal cancer.3.The pre-treatment CAR level could not predict the efficacy of first palliative chemotherapy.