Gastric Cancer

, Volume 22, Issue 3, pp 536–545 | Cite as

CRP/prealbumin, a novel inflammatory index for predicting recurrence after radical resection in gastric cancer patients: post hoc analysis of a randomized phase III trial

  • Jun Lu
  • Bin-bin Xu
  • Zhi-fang Zheng
  • Jian-wei Xie
  • Jia-bin Wang
  • Jian-xian Lin
  • Qi-yue Chen
  • Long-long Cao
  • Mi Lin
  • Ru-hong Tu
  • Ze-ning Huang
  • Chao-hui ZhengEmail author
  • Chang-Ming HuangEmail author
  • Ping LiEmail author
Original Article



Serum prealbumin (PALB) can predict the prognosis of patients with gastric cancer (GC). However, the prognostic value of combination of C-reactive protein and PALB (CRP/PALB) remains unclear.


A total of 419 gastric cancer patients included in a clinical trial (NCT02327481) were analyzed. The present study is a substudy of the trial. Receiver operating characteristic (ROC) curves were generated, and by calculating the areas under the curve (AUC) and the C-index, the discriminative ability of each inflammatory index was compared, including CRP/PALB, C-reactive protein/albumin, Glasgow prognostic score (GPS), modified GPS, systemic immune-inflammation index, neutrophil–lymphocyte ratio, and platelet–lymphocyte ratio.


Ultimately, 401 patients were included in this study. The optimal cutoff value of CRP/PALB was 17.7. According to this cutoff point, the entire sample was divided into a CRP/PALB < 17.7 (LCP) group and a CRP/PALB ≥ 17.7 (HCP) group, comprising 245 and 156 patients, respectively. There were 54 and 22 patients experienced recurrence in the HCP and LCP group, respectively, p < 0.001. Compared with traditional inflammatory indices, CRP/PALB had the highest AUC (0.707) and C-index (0.716), all p < 0.05. The post-recurrence survival (PRS) of patients in the HCP group was significantly shorter than that in the LCP group (p = 0.010), especially for pathological stage III patients (p = 0.015) or patients with distant (p = 0.018) or local (p = 0.023) recurrences.


The predictive value of preoperative CRP/PALB for the recurrence of GC is significantly better than traditional inflammatory indices. HCP significantly reduces the PRS, especially for pathological stage III patients or patients with distant or local recurrences.


Gastric cancer Inflammatory index CRP/prealbumin Recurrence Post-recurrence survival 



This study was funded by the Scientific and technological innovation joint capital projects of Fujian Province (2016Y9031). Construction Project of Fujian Province Minimally Invasive Medical Center (No. [2017]171). The second batch of special support funds for Fujian Province innovation and entrepreneurship talents (2016B013). QIHANG funds of Fujian Medical University (No. 2016QH025). Fujian province medical innovation project (2015-CXB-16). Fujian provincial health and family planning commission joint project (WKJ2016-2-27). Chinese physicians association young physician respiratory research fund.

Author contributions

JL, BX, ZZ and CH conceived the study, analyzed the data, and drafted the manuscript, C-HZ helped critically revise the manuscript for important intellectual content. PL, JX, JBW, J-XL, Q-YC, L–LC, ML, R-HT and Z-NH helped collect data and design the study.

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest or financial ties to disclose from any of author.

Human rights statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Informed consent

Informed consent or substitute for it was obtained from all patients for being included in the study.

Supplementary material

10120_2018_892_MOESM1_ESM.tif (1.4 mb)
Supplementary material 1 (TIF 1484 KB)
10120_2018_892_MOESM2_ESM.tif (2.6 mb)
Supplementary material 2 (TIF 2672 KB)
10120_2018_892_MOESM3_ESM.docx (15 kb)
Supplementary material 3 (DOCX 15 KB)


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  1. 1.Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
  2. 2.Key Laboratory of Ministry of Education of Gastrointestinal CancerFujian Medical UniversityFuzhouChina

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