Lymphocyte-C-Reactive Protein Ratio with Calf Circumference Could Better Predict Survival of Patients with Non-Metastatic Cancer

Abstract Background Systemic inflammatory responses caused by tumor cells play an important role in the occurrence and development of tumors. Most of these responses are accompanied by a decrease in muscle mass. The aim of this study was to identify biomarkers that most accurately predict prognoses in patients with non-metastatic cancer and to evaluate their clinical significance when combined with muscle markers. Methods This study retrospectively evaluated 2,797 cancer patients diagnosed with cancer at TNM stages I, II, and III. Lymphocyte-C-reactive protein ratio (LCR) in conjunction with calf circumference (CC) were used (or chosed) after evaluating the predictive value of 13 inflammatory marker combinations and five anthropometric indicators for patient outcomes using the C-index. The Kaplan-Meier method and Cox’s proportional hazards regression modeling were used to analyze the individual and combined effects of these two potential biomarkers on overall survival. Results This study enrolled 1,604 men (57.3%) and 1,193 women (42.7%) with a mean age of 58.75 years. Among the 13 inflammatory nutritional indicators, the LCR was the most accurate predictor of prognoses in patients with non-metastatic cancer. The optimal threshold for the LCR was 2,500. After multifactorial adjustment, we found that low LCR had an adverse effect on overall survival (hazard ratio [HR]: 2.50; 95% confidence interval [CI]: 2.17, 2.88; P<0.001). Low LCR combined with low CC was also shown to be an independent risk factor for poor overall survival (HR: 2.26; 95% CI: 1.80, 2.83; P<0.001). In non-metastatic cancer patients of different ages, stages, surgery history, and tumor types (for example, upper gastrointestinal cancer, colorectal cancer, lung cancer), patients with a low LCR combined with a low CC had statistically significantly reduced overall survival. Compared with LCR or CC alone, the combination of the two had greater prognostic value for patients with non-metastatic cancer. Conclusions The LCR can be implemented as a useful biomarker to predict prognoses in patients with non-metastatic cancer, its predictive value is superior to the other evaluated indicators of inflammation. CC is the best anthropometric indicator of muscle loss in patients with non-metastatic cancer. The combination of LCR and CC can better predict the prognosis of patients with non-metastatic cancer, and can provide important information for clinicians to formulate diagnosis and treatment plans.

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Prognostic value of lymphocyte-to-C-reactive protein ratio in patients with gastric cancer after surgery: a multicentre study

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa099 ◽

2020 ◽

Vol 50 (10) ◽

pp. 1141-1149 ◽

Cited By ~ 1

Author(s):

Chuan-bing Cheng ◽

Qu-xia Zhang ◽

Lv-Ping Zhuang ◽

Jian-wei Sun

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Cancer Patients ◽

Prognostic Marker ◽

Predictive Value ◽

Radical Gastrectomy ◽

C Reactive Protein ◽

Protein Ratio ◽

Reactive Protein ◽

Gastric Cancer Patients

Abstract Objective The immune inflammation-based score is recognized as a prognostic marker for cancer. However, the most accurate prognostic marker for patients with gastric cancer remains undetermined. We aimed to evaluate the predictive value of the lymphocyte-to-C-reactive protein ratio for outcomes in gastric cancer patients after radical gastrectomy. Methods A total of 607 gastric cancer patients treated at three Chinese institutions were included. Receiver operating characteristic curves were generated, and the areas under the curve were calculated to compare the predictive value among the inflammation-based score, lymphocyte-to-C-reactive protein ratio, C-reactive protein/albumin and neutrophil-lymphocyte, platelet-lymphocyte and lymphocyte-monocyte ratios. Cox regression was performed to determine the prognostic factors for overall survival. Results The median follow-up time was 63 months (range: 1–84 months). The optimal cut-off value for lymphocyte-to-C-reactive protein ratio was 0.63. The patients were divided into the LCR <0.63 (LLCR, n = 294) group and the LCR ≥0.63 (HLCR, n = 313) group. LLCR was significantly correlated with poor clinical characteristics. Compared with inflammation-based score, lymphocyte-to-C-reactive protein ratio had the highest areas under the curve (0.695). Patients with LLCR experienced more post-operative complications than the HLCR group (20.4 vs. 12.1%, P = 0.006). Multivariate analysis showed that a higher lymphocyte-to-C-reactive protein ratio (HR: 0.545, 95%CI: 0.372–0.799, P = 0.002) was associated with better overall survival. The HLCR group had higher 5-year overall survival rate than the LLCR group (80.5 vs. 54.9%, P < 0.001). Conclusions Preoperative lymphocyte-to-C-reactive protein ratio levels can effectively predict the short-term and oncological efficacy of gastric cancer patients after radical gastrectomy with a predictive value significantly better than other inflammation-based score.

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Procalcitonin and C-Reactive Protein/Procalcitonin Ratio as Markers of Infection in Patients With Solid Tumors

Frontiers in Medicine ◽

10.3389/fmed.2021.627967 ◽

2021 ◽

Vol 8 ◽

Author(s):

Matteo Vassallo ◽

Celine Michelangeli ◽

Roxane Fabre ◽

Sabrina Manni ◽

Pierre L. Genillier ◽

...

Keyword(s):

Positive Predictive Value ◽

Cancer Patients ◽

Negative Predictive Value ◽

Solid Tumors ◽

Predictive Value ◽

C Reactive Protein ◽

Reactive Protein ◽

Documented Infection ◽

Baseline Levels ◽

Sensitive Marker

Objectives: The roles of procalcitonin (PCT) and C-reactive protein (CRP) in febrile cancer patients is currently unclear. Our aim was to assess these in febrile patients with solid tumors and to identify cut-off values for ruling out infection.Methods: We retrospectively evaluated patients with solid tumors admitted to hospital due to fever. They were divided into those with Fever with microbiologically documented infection (FMDI), Fever with clinically documented infection (FCDI) and Tumor-related fever (TRF). PCT and CRP levels were compared. Receiver-operating curves were plotted to define the best cut-off values for discriminating between infection-related and cancer-related fever.Results: Between January 2015 to November 2018, 131 patients were recorded (mean age 68 years, 67% male, 86% with metastasis). Patients with FMDI or FCDI had significantly higher baseline levels of PCT and lower CRP/PCT than those with TRF. A PCT cut-off value of 0.52 ng/mL for discriminating between infection and cancer-associated fever yielded 75% sensitivity, 55% specificity, 77% positive predictive value (PPV), and 52% negative predictive value (NPV). A CRP/PCT ratio with a cut-off value of 95 showed 56% sensitivity, 70% specificity, 79% NPV, and 44% PPV.Discussion: PCT is a sensitive marker of sepsis or localized infection in patients with solid tumors, but its specificity is poor. The CRP/PCT ratio improves specificity, thus providing a reliable means of ruling out infection for values above 95.

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Crown-like structures in breast adipose tissue of breast cancer patients: associations with CD68 expression, obesity, metabolic factors and prognosis

npj Breast Cancer ◽

10.1038/s41523-021-00304-x ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Martin C. Chang ◽

Zohreh Eslami ◽

Marguerite Ennis ◽

Pamela J. Goodwin

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Adipose Tissue ◽

Cancer Patients ◽

Breast Cancer Patients ◽

C Reactive Protein ◽

Metabolic Factors ◽

Reactive Protein ◽

Breast Adipose Tissue ◽

Disease Free

AbstractCrown-like structures of the breast (CLS-B), defined by the clustering of macrophages (identified using CD68 immunohistochemical staining) to surround a dying adipocyte, are a sign of adipose-tissue inflammation. In human cohorts, CLS-B positively correlates with older age, obesity, dyslipidemia and higher levels of glucose, insulin, C-reactive protein and IL-6. In an existing cohort of early-stage breast cancer patients, CLS-B were identified using H&E stained histologic sections (hCLS-B), and by CD68 immunohistochemistry (CD68 + CLS-B). We examined associations of H&E and CD68-detected CLS-B with clinicopathologic features using χ2 tests, with metabolic factors using Wilcoxon rank sum tests and with disease free and overall survival using Cox regression models. hCLS-B were detected in 59 of 163 patients with slides (36.2%) and CD68 + CLS-B in 37 of 119 patients with paraffin blocks (31.1%). hCLS-B were positively correlated with higher weight (p = 0.003), BMI (p = 0.0008) and C-reactive protein (p = 0.045). CD68 + CLS-B were positively correlated with higher weight (p = 0.006), BMI p = 0.001), leptin (p = 0.034), insulin (p = 0.008) and Homeostasis Model Assessment (p = 0.027). CD68 + CLS-B were associated with poor distant disease-free with a hazard ratio (HR) of 2.81, 95% confidence interval (CI) 1.20–6.57, and overall survival with HR 3.97 (1.66–9.48), while hCLS-B were not associated with either: HR for distant recurrence 0.59 (0.26–1.30); HR for death 1.04 (0.50–2.16). The presence of hCLS-B and of CD68 + CLS-B were associated with obesity; CD68 + CLS-B were associated with insulin resistance and adverse prognosis. Similar patterns were not seen for hCLS-B. Research is needed to understand the biologic basis for these differences.

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Lymphocyte to C-reactive protein ratio predicts long-term outcomes for patients with lower rectal cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02319-x ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Masaaki Nishi ◽

Mistuo Shimada ◽

Takuya Tokunaga ◽

Jun Higashijima ◽

Kozo Yoshikawa ◽

...

Keyword(s):

Rectal Cancer ◽

Overall Survival ◽

Univariate Analysis ◽

Prognostic Significance ◽

Lower Rectal Cancer ◽

Significant Prognostic Factor ◽

C Reactive Protein ◽

Curative Surgery ◽

Protein Ratio ◽

Reactive Protein

Abstract Backgrounds The lymphocyte to C-reactive protein (CRP) ratio (LCR) is an indicator of systemic inflammation and host–tumor cell interactions. The aim of this study was to investigate the prognostic significance of LCR in lower rectal cancer patients who received preoperative chemo-radiotherapy (CRT). Methods Forty-eight patients with lower rectal cancer who underwent CRT followed by curative surgery were enrolled in this study. Routine blood examinations were performed before and after CRT were used to calculate pre-CRT LCR and post-CRT LCR. The median LCR was used to stratify patients into low and high LCR groups for analysis. The correlation between pre- and post-CRT LCR and clinical outcomes was retrospectively investigated. Results The pre-CRT LCR was significantly higher than the post-CRT LCR (11,765 and 6780, respectively, P < 0.05). The 5-year overall survival rate was significantly higher for patients with high post-CRT LCR compared with low post-CRT LCR (90.6% and 65.5%, respectively, P < 0.05). In univariate analysis, post-CRT LCR, post-CRT neutrophil to lymphocyte ratio, and fStage were significant prognostic factors for overall survival. In multivariate analysis, post-CRT LCR, but not other clinicopathological factors or prognostic indexes, was a significant prognostic factor for overall survival (P < 0.05). Conclusions Post-CRT LCR could be a prognostic biomarker for patients with lower rectal cancer.

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The Association of the Lymphocyte-to-C-Reactive-Protein Ratio With Gastric Cancer Patients Who Receive Curative Treatment

In Vivo ◽

10.21873/invivo.12728 ◽

2021 ◽

Vol 36 (1) ◽

pp. 482-489

Author(s):

TORU AOYAMA ◽

MASATO NAKAZANO ◽

SHINSUKE NAGASAWA ◽

KENTARO HARA ◽

KEISUKE KOMORI ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Patients ◽

Curative Treatment ◽

C Reactive Protein ◽

Protein Ratio ◽

Reactive Protein ◽

Gastric Cancer Patients

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Prognostic value of C-reactive protein/albumin ratio in predicting overall survival of Chinese cervical cancer patients overall survival: comparison among various inflammation based factors

Journal of Cancer ◽

10.7150/jca.23320 ◽

2018 ◽

Vol 9 (10) ◽

pp. 1877-1884 ◽

Cited By ~ 23

Author(s):

Xia He ◽

Jian-Pei Li ◽

Xiao-Hua Liu ◽

Jing-Ping Zhang ◽

Qiu-Yao Zeng ◽

...

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Cancer Patients ◽

Prognostic Value ◽

C Reactive Protein ◽

Albumin Ratio ◽

Reactive Protein

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C-Reactive Protein and Neutrophil/Lymphocytes Ratio: Prognostic Indicator for Doubling overall survival Prediction in Pancreatic Cancer Patients

Journal of Clinical Medicine ◽

10.3390/jcm8111791 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1791 ◽

Cited By ~ 2

Author(s):

Schlick ◽

Magnes ◽

Huemer ◽

Ratzinger ◽

Weiss ◽

...

Keyword(s):

Risk Factors ◽

Pancreatic Cancer ◽

Overall Survival ◽

Cancer Patients ◽

Locally Advanced ◽

Disease Stage ◽

C Reactive Protein ◽

First Line ◽

Reactive Protein ◽

Two Factors

: Background: Despite modern chemotherapy regimens, survival of patients with locally advanced/metastatic pancreatic cancer remains dismal. Long-term survivors are rare and there are no prognostic scores to identify patients benefitting most from chemotherapy. Methods: This retrospective study includes 240 patients with pancreatic cancer who were treated in a primary palliative setting between the years 2007 to 2016 in a single academic institution. Survival rates were analyzed using the Kaplan–Meier method. Prognostic models including laboratory and clinical parameters were calculated using Cox proportional models in univariate and multivariate analyses. Results: Median age at diagnosis was 67 years (range 29–90 years), 52% were female and a majority had an ECOG performance status of 0 or 1. Locally advanced pancreatic cancer was diagnosed in 23.3% (n = 56) and primary metastatic disease in 76.7% (n = 184) of all patients. Median overall survival of the whole study cohort was 8.3 months. Investigating potential risk factors like patient characteristics, tumor marker or inflammatory markers, multivariate survival analysis found CRP (c-reactive protein) and NLR (neutrophil to lymphocyte ratio) elevation before the start of palliative chemotherapy to be independent negative prognostic factors for OS (overall survival) (p < 0.001 and p < 0.01). Grouping patients with no risk factor versus patients with one or two of the above mentioned two risk factors, we found a median OS of 16.8 months and 9.4 months (p < 0.001) respectively. By combining these two factors, we were also able to identify pancreatic cancer patients that were more likely to receive any post first line therapy. These two risk factors are predictive for improved survival independent of disease stage (III or IV) and applied chemotherapy agents in first line. Conclusion: By combining these two factors, CRP and NLR, to create a score for OS, we propose a simple, new prognostic tool for OS prediction in pancreatic cancer.

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