Abstract
Background Systemic inflammation and malnutrition may promote tumor progression. C-reactive protein/albumin ratio (CAR) is linked with poor long-term survival of several malignant tumors.Purpose To explore the predictive value of CAR in gastrointestinal stromal tumors (GISTs).Methods A retrospective study was conducted on 325 patients with GIST who underwent radical surgery from 2009 to 2018. The cut-off point of CAR was set using X-tile software. Kaplan-Meier method and multivariate Cox regression model were used to study the prognostic value of CAR. The time-dependent receiver operating characteristic curve(tROC) was drawn, and the prognostic accuracy of CAR, Glasgow prognosis score (GPS), and NIH risk classification was compared by the area under the curve (AUC).Results The best cut-off point of CAR was 0.55. Increased CAR was associated with the location of the lower digestive tract, larger tumor size, higher mitotic index, higher NIH risk classification, lower ALB, higher CRP, and higher GPS (all p<0.05). Multivariable analysis revealed that CAR (hazard ratio [HR] 2.598, 95% confidence interval [CI] 1.385-4.874; p=0.003) was an independent predictor of overall survival. Additionally, the AUC of CAR was lower than that of NIH risk classification at 2-year (0.601vs. 0.775, p=0.002) and 5-year (0.629 vs. 0.735, p=0.069). However, the AUC of NIH risk classification was significantly increased (2-year OS 0.801, p=0.251; 5-year OS 0.777, p=0.011) when it was combined with CAR.Conclusions CAR is a new independent predictor of poor survival in patients with GIST. CAR combined with NIH risk classification can effectively improve the performance of prognosis prediction.
High C-reactive protein to albumin ratio and the short-term survival prognosis within 30 days in terminal cancer patients receiving palliative care in a hospital setting