Skip to main content
SpringerLink
Log in

Prognostic Significance of the Preoperative Ratio of C-Reactive Protein to Albumin and Neutrophil–Lymphocyte Ratio in Gastric Cancer Patients

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The ratio of C-reactive protein to albumin (CRP/Alb) is a biochemical marker of systemic inflammatory response and has been associated with poor survival in cancer. This study retrospectively investigated the relationship between the CRP/Alb ratio and prognosis in gastric cancer patients.

Methods

This study enrolled 453 patients with a histopathological diagnosis of gastric adenocarcinoma who underwent curative surgery.

Results

A statistically significant weak correlation was observed between CRP/Alb ratio and neutrophil/lymphocyte ratio (NLR) (r = 0.19; P < 0.0001). There were statistically significant correlations between high CRP/Alb ratio and age (P = 0.0004), tumor size (P = 0.02), depth of invasion (P = 0.012), and lymph node metastasis (P = 0.022). A high NLR was significantly correlated with age (P = 0.0027), tumor size (P = 0.0006), depth of invasion (P < 0.0001), lymphatic involvement (P = 0.0031), venous involvement (P = 0.0022), and stage of disease (P = 0.0024). Based on results by receiver operating characteristic analysis, patients were divided as follows: CRP/Alb ratio ≥ 0.0232 (CARHigh), CRP/Alb ratio < 0.0232 (CARLow), NLR ≥ 2.43 (NLRHigh), and NLR < 2.43 (NLRLow). Five-year survival rates of patients with both CARHigh and NLRHigh, either CARHigh or NLRHigh, and both CARLow and NLRLow were 59.6, 75.8, and 87.5%, respectively, with statistically significant differences (P < 0.0001). Multivariate analysis revealed that the combination of CRP/Alb ratio and NLR was an independent prognostic indicator.

Conclusions

The combination of CRP/Alb ratio and NLR may be useful in predicting prognosis in gastric cancer patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61:69–90

    Article  PubMed  Google Scholar 

  2. Park HJ, Ahn JY, Jung HY et al (2014) Clinical characteristics and outcomes for gastric cancer patients aged 18–30 years. Gastric Cancer 17:649–660

    Article  PubMed  Google Scholar 

  3. Nam DH, Lee YK, Park JC et al (2013) Prognostic value of early postoperative tumor marker response in gastric cancer. Ann Surg Oncol 20:3905–3911

    Article  PubMed  Google Scholar 

  4. Coussens LM, Werb Z (2002) Inflammation and cancer. Nature 420:860–867

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Kinoshita A, Onoda H, Imai N et al (2012) Comparison of the prognostic value of inflammation-based prognostic scores in patients with hepatocellular carcinoma. Br J Cancer 107:988–993

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Inoue D, Ozaka M, Matsuyama M et al (2015) Prognostic value of neutrophil–lymphocyte ratio and level of C-reactive protein in a large cohort of pancreatic cancer patients: a retrospective study in a single institute in Japan. Jpn J Clin Oncol 45:61–66

    Article  PubMed  Google Scholar 

  7. Fairclough E, Cairns E, Hamilton J et al (2009) Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein/albumin ratio as a predictor of patient outcome. Clin Med (Lond, Engl) 9:30–33

    Article  Google Scholar 

  8. Ranzani OT, Zampieri FG, Forte DN et al (2013) C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS ONE 8:e59321

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Kinoshita A, Onoda H, Imai N et al (2015) The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma. Ann Surg Oncol 22:803–810

    Article  PubMed  Google Scholar 

  10. Xu XL, Yu HQ, Hu W et al (2015) A novel inflammation-based prognostic score, the C-reactive protein/albumin ratio predicts the prognosis of patients with operable esophageal squamous cell carcinoma. PLoS ONE 10:e0138657

    Article  PubMed  PubMed Central  Google Scholar 

  11. Choi Y, Kim JW, Nam KH et al (2017) Systemic inflammation is associated with the density of immune cells in the tumor microenvironment of gastric cancer. Gastric Cancer 20:602–611

    Article  CAS  PubMed  Google Scholar 

  12. Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112

    Article  Google Scholar 

  13. Bozzetti F, Bonfanti G, Morabito A et al (1986) A multifactorial approach for the prognosis of patients with carcinoma of the stomach after curative resection. Surg Gynecol Obstet 162:229–234

    CAS  PubMed  Google Scholar 

  14. Maruyama K (1987) The most important prognostic factors for gastric cancer patients. Scand J Gastroenterol 22:63–68

    Article  Google Scholar 

  15. Morris-Stiff G, Gomez D, Prasad KR (2008) C-reactive protein in liver cancer surgery. Eur J Surg Oncol 34:727–729

    Article  CAS  PubMed  Google Scholar 

  16. Yu Q, Yu XF, Zhang SD et al (2013) Prognostic role of C-reactive protein in gastric cancer: a meta-analysis. Asian Pac J Cancer Prev APJCP 14:5735–5740

    Article  PubMed  Google Scholar 

  17. Detsky AS, McLaughlin JR, Baker JP et al (1987) What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 11:8–13

    Article  CAS  PubMed  Google Scholar 

  18. Vellas B, Villars H, Abellan G et al (2006) Overview of the MNA—its history and challenges. J Nutr Health Aging 10:456–463 (Discussion 463–455)

    CAS  PubMed  Google Scholar 

  19. Kondrup J, Rasmussen HH, Hamberg O et al (2003) Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22:321–336

    Article  PubMed  Google Scholar 

  20. Onodera T, Goseki N, Kosaki G (1984) Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi 85:1001–1005

    CAS  PubMed  Google Scholar 

  21. Nozoe T, Iguchi T, Egashira A et al (2011) Significance of modified Glasgow prognostic score as a useful indicator for prognosis of patients with gastric carcinoma. Am J Surg 201:186–191

    Article  PubMed  Google Scholar 

  22. Imaoka H, Mizuno N, Hara K et al (2016) Evaluation of modified glasgow prognostic score for pancreatic cancer: a retrospective cohort study. Pancreas 45:211–217

    Article  PubMed  Google Scholar 

  23. Nozoe T, Matono R, Ijichi H et al (2014) Glasgow prognostic score (GPS) can be a useful indicator to determine prognosis of patients with colorectal carcinoma. Int Surg 99:512–517

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hirashima K, Watanabe M, Shigaki H et al (2014) Prognostic significance of the modified Glasgow prognostic score in elderly patients with gastric cancer. J Gastroenterol 49:1040–1046

    Article  PubMed  Google Scholar 

  25. Liu Z, Jin K, Guo M et al (2017) Prognostic value of the CRP/Alb ratio, a novel inflammation-based score in pancreatic cancer. Ann Surg Oncol 24:561–568

    Article  CAS  PubMed  Google Scholar 

  26. Kim JH, Han DS, Bang HY et al (2015) Preoperative neutrophil-to-lymphocyte ratio is a prognostic factor for overall survival in patients with gastric cancer. Ann Surg Treat Res 89:81–86

    Article  PubMed  PubMed Central  Google Scholar 

  27. Stotz M, Gerger A, Eisner F et al (2013) Increased neutrophil–lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer. Br J Cancer 109:416–421

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Kumar R, Geuna E, Michalarea V et al (2015) The neutrophil–lymphocyte ratio and its utilisation for the management of cancer patients in early clinical trials. Br J Cancer 112:1157–1165

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Haruki K, Shiba H, Shirai Y et al (2016) The C-reactive protein to albumin ratio predicts long-term outcomes in patients with pancreatic cancer after pancreatic resection. World J Surg 40:2254–2260. https://doi.org/10.1007/s00268-016-3491-4

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, School of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan

    Hiroaki Saito, Yusuke Kono, Yuki Murakami, Yuji Shishido, Hirohiko Kuroda, Tomoyuki Matsunaga, Yoji Fukumoto, Tomohiro Osaki, Keigo Ashida & Yoshiyuki Fujiwara

Authors
  1. Hiroaki Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yusuke Kono
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuki Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuji Shishido
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hirohiko Kuroda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tomoyuki Matsunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yoji Fukumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tomohiro Osaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Keigo Ashida
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yoshiyuki Fujiwara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroaki Saito.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saito, H., Kono, Y., Murakami, Y. et al. Prognostic Significance of the Preoperative Ratio of C-Reactive Protein to Albumin and Neutrophil–Lymphocyte Ratio in Gastric Cancer Patients. World J Surg 42, 1819–1825 (2018). https://doi.org/10.1007/s00268-017-4400-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-017-4400-1

Search

Navigation