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Preoperative Albumin and Postoperative CRP/Albumin Ratio (CARS) are Independent Predictive Factors in Estimating 1-Year Mortality in Patients Operated for Proximal Femoral Metastasis with Endoprosthesis

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Abstract

Background

Proximal femur resection and prosthetic reconstruction are preferred in patients with extensive bone destruction, pathological fractures, tumours resistant to radiation therapy, and patients with more proximal metastatic lesions. There is increasing evidence that the CRP/albumin ratio (CAR) is an independent marker of inflammation in various primary organ cancers and maybe a more accurate prognostic factor. We aimed to evaluate whether preoperative and postoperative CAR values could be a factor in predicting mortality in these patients. We hypothesized that CAR could predict these patients' postoperative 90-day and 1-year mortality.

Methods

The patient's age and gender, primary tumour, number of bone metastases, and presence of visceral metastases were recorded using imaging techniques such as computed tomography and bone scan or positron emission tomography. The following laboratory data were analyzed before and after surgery.

Results

The mean age of the patients was 62.67 ± 14.8; 56.9% were female (n:29), and 43.1% were male (n:22). When the results of the ROC analysis of the parameters in predicting 1-year mortality were examined, and the cut-off value for preoperative albumin was taken as ≤ 3.75, the AUC value was found to be statistically significant as 0.745 (p:0.003). When the cut-off value for postoperative CAR was taken as ≥ 87.32, the AUC value was found to be 0.7 statistically significant (p:0.015).

Conclusion

Length of stay, preoperative albumin and postoperative CAR values can be used as independent predictive values in predicting 1-year mortality in patients undergoing endoprosthesis due to proximal femur metastasis.

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Authors and Affiliations

  1. Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey

    Ali Yüce, Mustafa Yerli, Nazım Erkurt, Kamil Berkay Akdere, Mehmet Kürşad Bayraktar, Murat Çakar & Müjdat Adaş

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  1. Ali Yüce
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Contributions

AY, MY, KBA, NE designed the protocol, reviewed the literature, analyzed the data, and critically reviewed and wrote the manuscript. MKB and MÇ analyzed the data, reviewed the literature, and critically reviewed and wrote the manuscript. MA designed the protocol, collected and analyzed the data, and reviewed the literature. All authors read and approved the final manuscript.

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Correspondence to Mustafa Yerli.

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The authors declare that they have no conflict of interest.

Ethical Standard

The study was approved by the institutional review board (Decision date and number: 27/09/2021 - 347) and performed in accordance with the ethical standards laid down in the Declaration of Helsinki.

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All patients provided written informed consent before their inclusion in the study.

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Yüce, A., Yerli, M., Erkurt, N. et al. Preoperative Albumin and Postoperative CRP/Albumin Ratio (CARS) are Independent Predictive Factors in Estimating 1-Year Mortality in Patients Operated for Proximal Femoral Metastasis with Endoprosthesis. JOIO (2024). https://doi.org/10.1007/s43465-024-01121-7

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