International Journal of Colorectal Disease

, Volume 34, Issue 6, pp 1105–1111 | Cite as

Prognostic significance of C-reactive protein to albumin ratio in colorectal cancer patients: a meta-analysis

  • Yu Fan
  • Shouyan Xiang
  • Zhe Dai
  • Chen Zou
  • Xiaoyan Wang
  • Zhenjun GaoEmail author
Original Article



Inconsistent results on the prognostic significance of C-reactive protein to albumin ratio (CAR) in colorectal cancer patients have been reported. This meta-analysis sought to assess the prognostic value of pretreatment CAR for survival outcomes in colorectal cancer patients.


We conducted a systematic literature search of PubMed and Embase databases until February 16, 2019. Observational studies investigating the prognostic role of pretreatment CAR for survival outcome in patients with colorectal cancer were included. Outcome measures included overall survival (OS), disease-free survival (DFS), or progression-free survival (PFS). Pooled hazard ratio (HR) with 95% confidence interval (CI) was utilized to summarize the prognostic significance of CAR for patient survival.


Nine retrospective studies involving 2492 colorectal cancer patients were identified. A fixed-effect model meta-analysis showed that high pretreatment CAR was an independent predictor of poor OS (HR 2.25; 95% CI 1.84–2.76) and DFS (HR 2.49; 95% CI 1.43–4.33). On the other hand, no significant association was observed between high CAR and PFS (HR 1.71; 95% CI 0.44–6.60). The predictive values of OS with high pretreatment CAR caused no significant changes in different sample sizes, countries, cut-off values of CAR, treatment methods, and study quality of subgroups.


This meta-analysis suggests that CAR may be a powerful prognostic indicator for colorectal cancer prognosis. High pretreatment CAR is associated with poor OS and DFS in patients with colorectal cancer.


C-reactive protein/albumin ratio Colorectal cancer Disease-free survival Overall survival Meta-analysis 


Funding information

This work was supported by (1) Jiangsu Provincial Key Research and Development Special Fund (BE2015666), (2) Jiangsu Innovative Team Leading Talent Fund (CXTDC2016006, QNRC2016446), (3) Natural Science Foundation of Jiangsu (BK20171304), (4) Jiangsu Six High Peak Talent Fund (WSW-205), and (5) Jiangsu 333 Talent Fund (BRA2016140).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

No informed consent.

Supplementary material

384_2019_3299_MOESM1_ESM.doc (26 kb)
ESM 1 (DOC 23 kb)
384_2019_3299_MOESM2_ESM.doc (40 kb)
ESM 2 (DOC 40.5 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Cancer Institute, the Affiliated People’s HospitalJiangsu UniversityZhenjiangChina
  2. 2.Department of Digestive Disease,The first people’s Hospital of Suqian CitySuqianChina
  3. 3.Department of Digestive DiseaseCentral Hospital of Shanghai Qingpu DistrictShanghaiPeople’s Republic of China

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