Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
권호 표지
DOI QR코드

DOI QR Code

C-reactive protein/albumin ratio as prognostic score in oral squamous cell carcinoma

  • Park, Heung-Chul (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University) ;
  • Kim, Moon-Young (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University) ;
  • Kim, Chul-Hwan (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University)
  • Received : 2016.04.26
  • Accepted : 2016.08.03
  • Published : 2016.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: Many studies have examined histopathological factors and various prognostic scores related to inflammation to predict outcomes. Here, we examined the prognostic value of the C-reactive protein/albumin (CRP/alb) ratio in oral squamous cell carcinoma (OSCC). Materials and Methods: This retrospective study included 40 patients with OSCC. Using univariate and multivariate analyses, we focused on the correlation of the CRP/alb ratio with clinicopathological characteristics and with overall survival. We then compared five inflammation-based prognostic scores, CRP/alb ratio, modified Glasgow Prognostic Score (mGPS), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and prognostic nutritional index (PNI), based on receiver operating characteristic (ROC) curves. Results: The optimal cut-off value for the CRP/alb ratio was 0.085. The group with a high CRP/alb ratio had a high TNM clinical stage (P=0.002) and larger primary tumors (P=0.029), with statistically significant differences in lymph node metastasis and distant metastasis. In addition, when the CRP/alb ratio was high, multivariate analysis showed a lower survival rate (P=0.002; hazard ratio=6.078), and the ROC curve showed more outstanding discriminatory ability regarding overall survival compared to other inflammation-based prognostic scores. Conclusion: The CRP/alb ratio can be an independent prognostic factor when predicting prognosis in OSCC and has good prognostic ability.

Keywords

References

  1. Sun JR, Kim SM, Seo MH, Kim MJ, Lee JH, Myoung H. Oral cancer incidence based on annual cancer statistics in Korea. J Korean Assoc Oral Maxillofac Surg 2012;38:20-8. https://doi.org/10.5125/jkaoms.2012.38.1.20
  2. Lo Muzio L, Santarelli A, Panzarella V, Campisi G, Carella M, Ciavarella D, et al. Oral squamous cell carcinoma and biological markers: an update on the molecules mainly involved in oral carcinogenesis. Minerva Stomatol 2007;56:341-7.
  3. Spencer KR, Ferguson JW, Wiesenfeld D. Current concepts in the management of oral squamous cell carcinoma. Aust Dent J 2002;47:284-9; quiz 351. https://doi.org/10.1111/j.1834-7819.2002.tb00539.x
  4. Klug C, Berzaczy D, Voracek M, Millesi W. Preoperative chemoradiotherapy in the management of oral cancer: a review. J Craniomaxillofac Surg 2008;36:75-88. https://doi.org/10.1016/j.jcms.2007.06.007
  5. Genden EM, Ferlito A, Silver CE, Takes RP, Suarez C, Owen RP, et al. Contemporary management of cancer of the oral cavity. Eur Arch Otorhinolaryngol 2010;267:1001-17. https://doi.org/10.1007/s00405-010-1206-2
  6. Geum DH, Roh YC, Yoon SY, Kim HG, Lee JH, Song JM, et al. The impact factors on 5-year survival rate in patients operated with oral cancer. J Korean Assoc Oral Maxillofac Surg 2013;39:207-16. https://doi.org/10.5125/jkaoms.2013.39.5.207
  7. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature 2008;454:436-44. https://doi.org/10.1038/nature07205
  8. Sun K, Chen S, Xu J, Li G, He Y. The prognostic significance of the prognostic nutritional index in cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2014;140:1537-49. https://doi.org/10.1007/s00432-014-1714-3
  9. Paramanathan A, Saxena A, Morris DL. A systematic review and meta-analysis on the impact of pre-operative neutrophil lymphocyte ratio on long term outcomes after curative intent resection of solid tumours. Surg Oncol 2014;23:31-9. https://doi.org/10.1016/j.suronc.2013.12.001
  10. Gomez D, Farid S, Malik HZ, Young AL, Toogood GJ, Lodge JP, et al. Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative resection for hepatocellular carcinoma. World J Surg 2008;32:1757-62. https://doi.org/10.1007/s00268-008-9552-6
  11. Pinato DJ, North BV, Sharma R. A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma: the prognostic nutritional index (PNI). Br J Cancer 2012;106:1439-45. https://doi.org/10.1038/bjc.2012.92
  12. Liu H, Wu Y, Wang Z, Yao Y, Chen F, Zhang H, et al. Pretreatment platelet-to-lymphocyte ratio (PLR) as a predictor of response to first-line platinum-based chemotherapy and prognosis for patients with non-small cell lung cancer. J Thorac Dis 2013;5:783-9.
  13. Khandavilli SD, Ceallaigh PO, Lloyd CJ, Whitaker R. Serum Creactive protein as a prognostic indicator in patients with oral squamous cell carcinoma. Oral Oncol 2009;45:912-4. https://doi.org/10.1016/j.oraloncology.2009.03.015
  14. Jin Y, Zhao L, Peng F. Prognostic impact of serum albumin levels on the recurrence of stage I non-small cell lung cancer. Clinics (Sao Paulo) 2013;68:686-93. https://doi.org/10.6061/clinics/2013(05)17
  15. Liu X, Sun X, Liu J, Kong P, Chen S, Zhan Y, et al. Preoperative C-reactive protein/albumin ratio predicts prognosis of patients after curative resection for gastric cancer. Transl Oncol 2015;8:339-45. https://doi.org/10.1016/j.tranon.2015.06.006
  16. Zhou T, Zhan J, Hong S, Hu Z, Fang W, Qin T, et al. Ratio of Creactive protein/albumin is an inflammatory prognostic score for predicting overall survival of patients with small-cell lung cancer. Sci Rep 2015;5:10481. https://doi.org/10.1038/srep10481
  17. Wei XL, Wang FH, Zhang DS, Qiu MZ, Ren C, Jin Y, et al. A novel inflammation-based prognostic score in esophageal squamous cell carcinoma: the C-reactive protein/albumin ratio. BMC Cancer 2015;15:350. https://doi.org/10.1186/s12885-015-1379-6
  18. Kinoshita A, Onoda H, Imai N, Iwaku A, Oishi M, Tanaka K, et al. The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma. Ann Surg Oncol 2015;22:803-10. https://doi.org/10.1245/s10434-014-4048-0
  19. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010;17:1471-4. https://doi.org/10.1245/s10434-010-0985-4
  20. Budczies J, Klauschen F, Sinn BV, Gyorffy B, Schmitt WD, Darb-Esfahani S, et al. Cutoff Finder: a comprehensive and straightforward Web application enabling rapid biomarker cutoff optimization. PLoS One 2012;7:e51862. https://doi.org/10.1371/journal.pone.0051862
  21. Diakos CI, Charles KA, McMillan DC, Clarke SJ. Cancerrelated inflammation and treatment effectiveness. Lancet Oncol 2014;15:e493-503. https://doi.org/10.1016/S1470-2045(14)70263-3
  22. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell 2011;144:646-74. https://doi.org/10.1016/j.cell.2011.02.013
  23. Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet 2001;357:539-45. https://doi.org/10.1016/S0140-6736(00)04046-0
  24. Allavena P, Germano G, Marchesi F, Mantovani A. Chemokines in cancer related inflammation. Exp Cell Res 2011;317:664-73. https://doi.org/10.1016/j.yexcr.2010.11.013
  25. Castell JV, Gomez-Lechon MJ, David M, Fabra R, Trullenque R, Heinrich PC. Acute-phase response of human hepatocytes: regulation of acute-phase protein synthesis by interleukin-6. Hepatology 1990;12:1179-86. https://doi.org/10.1002/hep.1840120517
  26. Gallo O, Gori AM, Attanasio M, Martini F, Giusti B, Brunelli T, et al. Interleukin-6 and acute-phase proteins in head and neck cancer. Eur Arch Otorhinolaryngol 1995;252:159-62.
  27. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest 2003;111:1805-12. https://doi.org/10.1172/JCI200318921
  28. Coussens LM, Werb Z. Inflammation and cancer. Nature 2002;420:860-7. https://doi.org/10.1038/nature01322
  29. Nozoe T, Saeki H, Sugimachi K. Significance of preoperative elevation of serum C-reactive protein as an indicator of prognosis in esophageal carcinoma. Am J Surg 2001;182:197-201. https://doi.org/10.1016/S0002-9610(01)00684-5
  30. Gockel I, Dirksen K, Messow CM, Junginger T. Significance of preoperative C-reactive protein as a parameter of the perioperative course and long-term prognosis in squamous cell carcinoma and adenocarcinoma of the oesophagus. World J Gastroenterol 2006;12:3746-50. https://doi.org/10.3748/wjg.v12.i23.3746
  31. von Meyenfeldt M. Cancer-associated malnutrition: an introduction. Eur J Oncol Nurs 2005;9 Suppl 2:S35-8. https://doi.org/10.1016/j.ejon.2005.09.001
  32. Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J 2010;9:69. https://doi.org/10.1186/1475-2891-9-69
  33. Alberici Pastore C, Paiva Orlandi S, Gonzalez MC. Association between an inflammatory-nutritional index and nutritional status in cancer patients. Nutr Hosp 2013;28:188-93.
  34. Roxburgh CS, McMillan DC. Cancer and systemic inflammation: treat the tumour and treat the host. Br J Cancer 2014;110:1409-12. https://doi.org/10.1038/bjc.2014.90
  35. Metgud R, Patel S. Serum and salivary levels of albumin as diagnostic tools for oral pre-malignancy and oral malignancy. Biotech Histochem 2014;89:8-13. https://doi.org/10.3109/10520295.2013.793394
  36. Rachidi S, Wallace K, Wrangle JM, Day TA, Alberg AJ, Li Z. Neutrophil-to-lymphocyte ratio and overall survival in all sites of head and neck squamous cell carcinoma. Head Neck 2016;38 Suppl 1:E1068-74. https://doi.org/10.1002/hed.24159
  37. Farhan-Alanie OM, McMahon J, McMillan DC. Systemic inflammatory response and survival in patients undergoing curative resection of oral squamous cell carcinoma. Br J Oral Maxillofac Surg 2015;53:126-31. https://doi.org/10.1016/j.bjoms.2014.10.007
  38. Fang HY, Huang XY, Chien HT, Chang JT, Liao CT, Huang JJ, et al. Refining the role of preoperative C-reactive protein by neutrophil/lymphocyte ratio in oral cavity squamous cell carcinoma. Laryngoscope 2013;123:2690-9. https://doi.org/10.1002/lary.24105
  39. Fairclough E, Cairns E, Hamilton J, Kelly C. 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) 2009;9:30-3. https://doi.org/10.7861/clinmedicine.9-1-30
  40. Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M. Creactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS One 2013;8:e59321. https://doi.org/10.1371/journal.pone.0059321
  41. Xu XL, Yu HQ, Hu W, Song Q, Mao WM. A novel inflammationbased prognostic score, the C-reactive protein/albumin ratio predicts the prognosis of patients with operable esophageal squamous cell carcinoma. PLoS One 2015;10:e0138657. https://doi.org/10.1371/journal.pone.0138657
  42. Proctor MJ, Horgan PG, Talwar D, Fletcher CD, Morrison DS, McMillan DC. Optimization of the systemic inflammation-based Glasgow prognostic score: a Glasgow Inflammation Outcome Study. Cancer 2013;119:2325-32. https://doi.org/10.1002/cncr.28018
  43. Proctor MJ, Morrison DS, Talwar D, Balmer SM, O'Reilly DS, Foulis AK, et al. An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: a Glasgow Inflammation Outcome Study. Br J Cancer 2011;104:726-34. https://doi.org/10.1038/sj.bjc.6606087
  44. Shafique K, Proctor MJ, McMillan DC, Leung H, Smith K, Sloan B, et al. The modified Glasgow prognostic score in prostate cancer: results from a retrospective clinical series of 744 patients. BMC Cancer 2013;13:292. https://doi.org/10.1186/1471-2407-13-292
  45. Zhou T, Hong S, Hu Z, Hou X, Huang Y, Zhao H, et al. A systemic inflammation-based prognostic scores (mGPS) predicts overall survival of patients with small-cell lung cancer. Tumour Biol 2015;36:337-43. https://doi.org/10.1007/s13277-014-2623-4
  46. McMillan DC. The systemic inflammation-based Glasgow Prognostic Score: a decade of experience in patients with cancer. Cancer Treat Rev 2013;39:534-40. https://doi.org/10.1016/j.ctrv.2012.08.003

Cited by

  1. Mediators of Inflammation – A Potential Source of Biomarkers in Oral Squamous Cell Carcinoma vol.2018, pp.None, 2018, https://doi.org/10.1155/2018/1061780
  2. The value of preoperative Glasgow Prognostic Score and the C-Reactive Protein to Albumin Ratio as prognostic factors for long-term survival in pathological T1N0 esophageal squamous cell carcinoma vol.9, pp.5, 2016, https://doi.org/10.7150/jca.22755
  3. Neutrophil‐to‐lymphocyte ratio as a prognostic indicator in head and neck cancer: A systematic review and meta‐analysis vol.40, pp.11, 2018, https://doi.org/10.1002/hed.25324
  4. Platelet-Lymphocyte Ratio as a Predictor of Prognosis in Head and Neck Cancer: A Systematic Review and Meta-Analysis vol.42, pp.12, 2016, https://doi.org/10.1159/000502750
  5. Preoperative C‐reactive protein to albumin ratio is a predictor of survival after pancreatic resection for pancreatic ductal adenocarcinoma vol.15, pp.5, 2019, https://doi.org/10.1111/ajco.13123
  6. C-Reactive Protein/Albumin Ratio Is an Independent Prognostic Predictor of Survival in Advanced Cancer Patients Receiving Palliative Care vol.22, pp.12, 2019, https://doi.org/10.1089/jpm.2019.0102
  7. Diagnostic and Prognostic Value of Salivary Biochemical Markers in Oral Squamous Cell Carcinoma vol.10, pp.10, 2016, https://doi.org/10.3390/diagnostics10100818
  8. Prognostic Value of C-Reactive Protein-to-Albumin Ratio in Head and Neck Cancer: A Meta-Analysis vol.11, pp.3, 2016, https://doi.org/10.3390/diagnostics11030403
  9. Association between the C-reactive protein/albumin ratio and prognosis in patients with oral squamous cell carcinoma vol.11, pp.1, 2016, https://doi.org/10.1038/s41598-021-83362-2
  10. Preoperative C-reactive protein to albumin ratio and oral health in oral squamous cell carcinoma patients vol.21, pp.1, 2016, https://doi.org/10.1186/s12903-021-01516-0