The C-Reactive Protein/Albumin Ratio is a Novel Significant Prognostic Factor in Patients with Malignant Pleural Mesothelioma: A Retrospective Multi-institutional Study

Shinkichi Takamori, Gouji Toyokawa, Mototsugu Shimokawa, Fumihiko Kinoshita, Yuka Kozuma, Taichi Matsubara, Naoki Haratake, Takaki Akamine, Fumihiko Hirai, Takashi Seto, Tetsuzo Tagawa, Mitsuhiro Takenoyama, Yukito Ichinose, Yoshihiko Maehara

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Malignant pleural mesothelioma (MPM), a devastating neoplasm, is traditionally considered to be resistant to antitumor therapy. Identification of clinical prognostic indicators is therefore needed. Although the C-reactive protein/albumin ratio (CAR) has been used to predict the prognosis of many types of malignancy, its utility in patients with MPM is unknown. Methods: The data of 100 patients diagnosed as having MPM from 1995 to 2015 at the National Kyushu Cancer Center and Kyushu University were analyzed. The CAR was calculated as serum C-reactive protein concentration divided by albumin concentration. A cutoff for CAR was set at 0.58 according to a receiver operating characteristics curve for 1-year survival. Results: Thirty-five of the 100 (35.0%) patients were classified as having a high CAR. A high CAR was significantly associated with advanced clinical stage (p < 0.001) and chemotherapy alone (p = 0.002). Patients with a high CAR had significantly shorter overall survival (OS) (p < 0.001) and disease- or progression-free survival (DFS/PFS) (p < 0.001). These associations between CAR and prognosis remained significant after propensity score-matching. In multivariate analysis, a high CAR was an independent predictor of shorter OS and DFS/PFS (p = 0.003 and p = 0.008, respectively). Multivariate analyses of the subgroups of patients who had received chemotherapy and of patients who had undergone surgery also showed that a high CAR was an independent predictor of shorter OS and DFS/PFS. Conclusions: CAR is an independent predictor of prognosis in MPM patients. This prognostic index contributes to clinicians’ ability to predict benefit from treatment. Further larger, prospective studies are necessary to validate these findings.

Original languageEnglish
Pages (from-to)1555-1563
Number of pages9
JournalAnnals of Surgical Oncology
Volume25
Issue number6
DOIs
Publication statusPublished - Jun 1 2018

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C-Reactive Protein
Albumins
Survival
Malignant Mesothelioma
Multivariate Analysis
Drug Therapy
Neoplasms
Propensity Score
ROC Curve
Disease-Free Survival
Disease Progression
Blood Proteins
Prospective Studies
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

Cite this

The C-Reactive Protein/Albumin Ratio is a Novel Significant Prognostic Factor in Patients with Malignant Pleural Mesothelioma : A Retrospective Multi-institutional Study. / Takamori, Shinkichi; Toyokawa, Gouji; Shimokawa, Mototsugu; Kinoshita, Fumihiko; Kozuma, Yuka; Matsubara, Taichi; Haratake, Naoki; Akamine, Takaki; Hirai, Fumihiko; Seto, Takashi; Tagawa, Tetsuzo; Takenoyama, Mitsuhiro; Ichinose, Yukito; Maehara, Yoshihiko.

In: Annals of Surgical Oncology, Vol. 25, No. 6, 01.06.2018, p. 1555-1563.

Research output: Contribution to journalArticle

Takamori, S, Toyokawa, G, Shimokawa, M, Kinoshita, F, Kozuma, Y, Matsubara, T, Haratake, N, Akamine, T, Hirai, F, Seto, T, Tagawa, T, Takenoyama, M, Ichinose, Y & Maehara, Y 2018, 'The C-Reactive Protein/Albumin Ratio is a Novel Significant Prognostic Factor in Patients with Malignant Pleural Mesothelioma: A Retrospective Multi-institutional Study', Annals of Surgical Oncology, vol. 25, no. 6, pp. 1555-1563. https://doi.org/10.1245/s10434-018-6385-x
Takamori, Shinkichi ; Toyokawa, Gouji ; Shimokawa, Mototsugu ; Kinoshita, Fumihiko ; Kozuma, Yuka ; Matsubara, Taichi ; Haratake, Naoki ; Akamine, Takaki ; Hirai, Fumihiko ; Seto, Takashi ; Tagawa, Tetsuzo ; Takenoyama, Mitsuhiro ; Ichinose, Yukito ; Maehara, Yoshihiko. / The C-Reactive Protein/Albumin Ratio is a Novel Significant Prognostic Factor in Patients with Malignant Pleural Mesothelioma : A Retrospective Multi-institutional Study. In: Annals of Surgical Oncology. 2018 ; Vol. 25, No. 6. pp. 1555-1563.
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abstract = "Background: Malignant pleural mesothelioma (MPM), a devastating neoplasm, is traditionally considered to be resistant to antitumor therapy. Identification of clinical prognostic indicators is therefore needed. Although the C-reactive protein/albumin ratio (CAR) has been used to predict the prognosis of many types of malignancy, its utility in patients with MPM is unknown. Methods: The data of 100 patients diagnosed as having MPM from 1995 to 2015 at the National Kyushu Cancer Center and Kyushu University were analyzed. The CAR was calculated as serum C-reactive protein concentration divided by albumin concentration. A cutoff for CAR was set at 0.58 according to a receiver operating characteristics curve for 1-year survival. Results: Thirty-five of the 100 (35.0{\%}) patients were classified as having a high CAR. A high CAR was significantly associated with advanced clinical stage (p < 0.001) and chemotherapy alone (p = 0.002). Patients with a high CAR had significantly shorter overall survival (OS) (p < 0.001) and disease- or progression-free survival (DFS/PFS) (p < 0.001). These associations between CAR and prognosis remained significant after propensity score-matching. In multivariate analysis, a high CAR was an independent predictor of shorter OS and DFS/PFS (p = 0.003 and p = 0.008, respectively). Multivariate analyses of the subgroups of patients who had received chemotherapy and of patients who had undergone surgery also showed that a high CAR was an independent predictor of shorter OS and DFS/PFS. Conclusions: CAR is an independent predictor of prognosis in MPM patients. This prognostic index contributes to clinicians’ ability to predict benefit from treatment. Further larger, prospective studies are necessary to validate these findings.",
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T1 - The C-Reactive Protein/Albumin Ratio is a Novel Significant Prognostic Factor in Patients with Malignant Pleural Mesothelioma

T2 - A Retrospective Multi-institutional Study

AU - Takamori, Shinkichi

AU - Toyokawa, Gouji

AU - Shimokawa, Mototsugu

AU - Kinoshita, Fumihiko

AU - Kozuma, Yuka

AU - Matsubara, Taichi

AU - Haratake, Naoki

AU - Akamine, Takaki

AU - Hirai, Fumihiko

AU - Seto, Takashi

AU - Tagawa, Tetsuzo

AU - Takenoyama, Mitsuhiro

AU - Ichinose, Yukito

AU - Maehara, Yoshihiko

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background: Malignant pleural mesothelioma (MPM), a devastating neoplasm, is traditionally considered to be resistant to antitumor therapy. Identification of clinical prognostic indicators is therefore needed. Although the C-reactive protein/albumin ratio (CAR) has been used to predict the prognosis of many types of malignancy, its utility in patients with MPM is unknown. Methods: The data of 100 patients diagnosed as having MPM from 1995 to 2015 at the National Kyushu Cancer Center and Kyushu University were analyzed. The CAR was calculated as serum C-reactive protein concentration divided by albumin concentration. A cutoff for CAR was set at 0.58 according to a receiver operating characteristics curve for 1-year survival. Results: Thirty-five of the 100 (35.0%) patients were classified as having a high CAR. A high CAR was significantly associated with advanced clinical stage (p < 0.001) and chemotherapy alone (p = 0.002). Patients with a high CAR had significantly shorter overall survival (OS) (p < 0.001) and disease- or progression-free survival (DFS/PFS) (p < 0.001). These associations between CAR and prognosis remained significant after propensity score-matching. In multivariate analysis, a high CAR was an independent predictor of shorter OS and DFS/PFS (p = 0.003 and p = 0.008, respectively). Multivariate analyses of the subgroups of patients who had received chemotherapy and of patients who had undergone surgery also showed that a high CAR was an independent predictor of shorter OS and DFS/PFS. Conclusions: CAR is an independent predictor of prognosis in MPM patients. This prognostic index contributes to clinicians’ ability to predict benefit from treatment. Further larger, prospective studies are necessary to validate these findings.

AB - Background: Malignant pleural mesothelioma (MPM), a devastating neoplasm, is traditionally considered to be resistant to antitumor therapy. Identification of clinical prognostic indicators is therefore needed. Although the C-reactive protein/albumin ratio (CAR) has been used to predict the prognosis of many types of malignancy, its utility in patients with MPM is unknown. Methods: The data of 100 patients diagnosed as having MPM from 1995 to 2015 at the National Kyushu Cancer Center and Kyushu University were analyzed. The CAR was calculated as serum C-reactive protein concentration divided by albumin concentration. A cutoff for CAR was set at 0.58 according to a receiver operating characteristics curve for 1-year survival. Results: Thirty-five of the 100 (35.0%) patients were classified as having a high CAR. A high CAR was significantly associated with advanced clinical stage (p < 0.001) and chemotherapy alone (p = 0.002). Patients with a high CAR had significantly shorter overall survival (OS) (p < 0.001) and disease- or progression-free survival (DFS/PFS) (p < 0.001). These associations between CAR and prognosis remained significant after propensity score-matching. In multivariate analysis, a high CAR was an independent predictor of shorter OS and DFS/PFS (p = 0.003 and p = 0.008, respectively). Multivariate analyses of the subgroups of patients who had received chemotherapy and of patients who had undergone surgery also showed that a high CAR was an independent predictor of shorter OS and DFS/PFS. Conclusions: CAR is an independent predictor of prognosis in MPM patients. This prognostic index contributes to clinicians’ ability to predict benefit from treatment. Further larger, prospective studies are necessary to validate these findings.

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