ASO Author Reflections: C-Reactive Protein/Albumin Ratio as a Prognostic Factor in Patients with Malignant Pleural Mesothelioma: What Does the Novel Index Represent?

Our plain-English summary of ASO Author Reflections: C-Reactive Protein/Albumin Ratio as a Prognostic Factor in Patients with Malignant Pleural Mesothelioma: What Does the Novel Index Represent?, by S. Takamori, M. Takenoyama (Annals of Surgical Oncology, 2018).

The study

• Authors: S. Takamori, M. Takenoyama
• Journal: Annals of Surgical Oncology
• Published: 2018;25(Suppl 3):958-959
• Type of article: Comment
• Read it: PubMed · Publisher

In plain English

This is a brief invited commentary in which the authors reflected on their own retrospective multi-institutional study, which was published separately. It is not the full study report, and it does not mention asbestos. In that study, the authors analyzed data from 100 patients with malignant pleural mesothelioma. Before treatment, they calculated each patient's C-reactive protein/albumin ratio (CAR), which is the blood level of C-reactive protein divided by the blood level of albumin. They set a cut-off value based on 1-year survival. Patients with a high CAR had significantly shorter overall survival and shorter disease-free or progression-free survival. These associations remained significant after a propensity score adjustment for clinical stage, histopathology, performance status and therapy. In multivariate analyses, a high CAR independently predicted shorter survival. Subgroup analyses of patients treated only with chemotherapy, or treated with surgery, gave the same pattern. The commentary gives no effect sizes and no cut-off value. The authors suggested that a high CAR may reflect impaired immune responses. They noted that their study did not show this link, and they called for studies of immunotherapy in patients with a high CAR.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Brief invited commentary by the authors on their own retrospective multi-institutional study, which was published separately in Ann Surg Oncol 2018;25:1555–1563
• Who was studied: 100 patients diagnosed with malignant pleural mesothelioma (MPM); the commentary does not state the place or the years of the study
• Exposure: No asbestos exposure is described. The factor studied was the C-reactive protein/albumin ratio (CAR): serum CRP divided by serum albumin, measured before treatment. The cut-off was chosen with a receiver operating characteristic curve for 1-year survival.
• Main results:
  • Patients with a high CAR had significantly shorter overall survival and shorter disease-free or progression-free survival (no numbers given in the commentary)
  • After propensity score adjustment for clinical stage, histopathology, performance status and therapy, the associations between CAR and prognosis remained significant
  • In multivariate analyses, a high CAR was an independent predictor of shorter overall, disease-free and progression-free survival
  • In subgroups limited to patients who received only chemotherapy, or to patients who had surgery, CAR still predicted prognosis
• The authors' conclusion: The authors suggested that a high CAR may reflect impaired immune responses in a patient
• Limitations the authors state:
  • The study did not show a relationship between a high CAR and immune status; the authors said future studies of immunotherapy in patients with a high CAR are needed
  • The study was retrospective; the authors used a propensity score analysis to reduce the bias of this design

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma.

Related studies

• The C-Reactive Protein/Albumin Ratio is a Novel Significant Prognostic Factor in Patients with Malignant Pleural Mesothelioma: A Retrospective Multi-institutional Study — S. Takamori, G. Toyokawa, et al. (2018)
• The C-Reactive Protein/Albumin Ratio May Predict the Long-Term Outcome in Patients with Malignant Pleural Mesothelioma — N. Yoshida, H. Baba (2018)
• Low calretinin expression and high neutrophil-to-lymphocyte ratio are poor prognostic factors in patients with malignant mesothelioma undergoing extrapleural pneumonectomy — S.C. Kao, S. Klebe, et al. (2011)
• Serum albumin as a significant prognostic factor in patients with malignant pleural mesothelioma — Z.H. Yao, G.Y. Tian, et al. (2014)
• Pretreatment serum C-reactive protein levels predict benefit from multimodality treatment including radical surgery in malignant pleural mesothelioma: a retrospective multicenter analysis — B. Ghanim, M.A. Hoda, et al. (2012)
• Survival and prognostic factors in malignant pleural mesothelioma: a retrospective study of 314 patients in the west part of Japan — S. Nojiri, K. Gemba, et al. (2011)

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