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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 volume 25, pages 1555–1563 (2018)Cite this article

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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Acknowledgment

The authors thank Dr. Trish Reynolds, MBBS, FRACP, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Disclosure

The authors declare no conflicts of interest in association with the present study.

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Affiliations

  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Shinkichi Takamori MD, Gouji Toyokawa PhD, Fumihiko Kinoshita MD, Yuka Kozuma MD, Taichi Matsubara MD, Naoki Haratake MD, Takaki Akamine MD, Fumihiko Hirai PhD, Tetsuzo Tagawa PhD & Yoshihiko Maehara PhD

  2. Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan

    Shinkichi Takamori MD, Mototsugu Shimokawa PhD, Takashi Seto PhD, Mitsuhiro Takenoyama PhD & Yukito Ichinose PhD

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  1. Shinkichi Takamori MD
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Correspondence to Mitsuhiro Takenoyama PhD.

Electronic supplementary material

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10434_2018_6385_MOESM1_ESM.tiff

Supplementary Fig. 1 Receiver operating characteristic curve for 1-year survival showing that C-reactive protein/albumin ratio has a good diagnostic ability with 80.0% sensitivity and 67.9% specificity. The area under the curve was calculated as 0.782. Supplementary material 1 (TIFF 2787 kb)

10434_2018_6385_MOESM2_ESM.tiff

Supplementary Fig. 2 Kaplan–Meier curves of overall survival (OS) and disease- or progression-free survival (DFS/PFS) according to C-reactive protein/albumin ratio in patients with stage I/II disease. The (a) OS and (b) DFS/PFS of the groups did not differ to a statistically extent (p = 0.079 and p = 0.062, respectively). Supplementary material 2 (TIFF 2787 kb)

Supplementary material 3 (DOCX 48 kb)

Supplementary material 4 (DOCX 49 kb)

Supplementary material 5 (DOCX 49 kb)

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Takamori, S., Toyokawa, G., Shimokawa, M. et al. The C-Reactive Protein/Albumin Ratio is a Novel Significant Prognostic Factor in Patients with Malignant Pleural Mesothelioma: A Retrospective Multi-institutional Study. Ann Surg Oncol 25, 1555–1563 (2018). https://doi.org/10.1245/s10434-018-6385-x

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Keywords

  • Malignant Pleural Mesothelioma (MPM)
  • National Kyushu Cancer Center
  • Propensity Score Matching
  • Advanced Clinical Stage
  • International Mesothelioma Interest Group (IMIG)