The C-Reactive Protein/Albumin Ratio May Predict the Long-Term Outcome in Patients with Malignant Pleural Mesothelioma

Our plain-English summary of The C-Reactive Protein/Albumin Ratio May Predict the Long-Term Outcome in Patients with Malignant Pleural Mesothelioma, by N. Yoshida, H. Baba (Annals of Surgical Oncology, 2018).

The study

• Authors: N. Yoshida, H. Baba
• Journal: Annals of Surgical Oncology
• Published: 2018;25(6):1471-1472
• Type of article: Editorial, Comment
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This editorial, by two surgeons at Kumamoto University, Japan, commented on a study by Takamori et al. of the serum C-reactive protein/albumin ratio (CAR) as a prognostic marker in malignant pleural mesothelioma (MPM). The authors first outlined the background. MPM is one of the most lethal neoplasms, and long-term outcomes remain insufficient despite multimodal treatment with extrapleural pneumonectomy, chemotherapy and radiotherapy. They noted that various markers of inflammation and nutrition had been suggested as prognostic indicators. Takamori et al. had retrospectively studied 100 MPM patients treated with chemotherapy alone, neoadjuvant chemotherapy followed by surgery, or surgery alone. They used propensity score matching for clinical stage, histopathology, performance status and treatment type, and concluded that CAR was an independent prognostic factor for overall survival and disease-free/progression-free survival. The editorialists described this as the first study to show the importance of CAR in MPM. They noted that CAR can be calculated easily from routine blood tests, and they considered the proposed mechanisms reasonable. However, they said it was unclear how CAR should be used in practice and how patients with elevated CAR should be treated. They identified limitations: the number of patients was not large, only 35 underwent surgery, and recruitment spanned 1995–2015, which raised the possibility of historical biases. They concluded that larger multi-institutional studies were desirable.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This is an editorial, not an original study. Its two authors commented on a separate study by Takamori et al. of malignant pleural mesothelioma, a cancer of the lining around the lungs. Asbestos was not discussed. According to the editorial, Takamori et al. looked back at 100 patients treated with chemotherapy alone, chemotherapy followed by surgery, or surgery alone. They examined a blood-test measure taken before treatment, the C-reactive protein/albumin ratio (CAR), which reflects inflammation and nutrition. Using a statistical matching method to reduce bias, Takamori et al. concluded that CAR independently predicted overall survival and disease-free or progression-free survival. The editorial's authors listed limitations. The number of patients was not large, and only 35 had surgery. Patients were also recruited over a long period, 1995 to 2015. The editorial's authors also said it is unclear how CAR should be used in practice. They concluded that the study suggests pretreatment CAR has clinical value as a marker of likely outcome, but that larger studies at multiple institutions are desirable.

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: editorial commenting on another study (Takamori et al.); the editorial itself reports no new data
• Who was studied: As described in the editorial, Takamori et al. retrospectively studied 100 malignant pleural mesothelioma patients treated with chemotherapy alone, neoadjuvant chemotherapy followed by surgery, or surgery alone, recruited between 1995 and 2015
• Exposure: No asbestos exposure was discussed. The factor examined was the pretreatment serum C-reactive protein/albumin ratio (CAR), a marker of inflammation and nutrition
• Main results:
  • Takamori et al. (not the editorial's authors) concluded that CAR was an independent prognostic factor for overall survival and disease-free or progression-free survival
  • Takamori et al. used propensity score matching on clinical stage, histopathology type, performance status and treatment type to reduce bias
  • Of the 100 patients, only 35 underwent surgery, although a high CAR was reported as an independent predictor of shorter survival after surgery
  • The editorial's authors noted that CAR can be calculated from routine blood test data
• The authors' conclusion: The editorial's authors concluded that the Takamori et al. study suggests the clinical importance of pretreatment CAR as a prognostic marker in malignant pleural mesothelioma, but that larger multi-institutional research is desirable to establish its usefulness and reliability
• Limitations the authors state:
  • The number of enrolled patients was not large
  • Patients were recruited over a long period (1995 to 2015), which brings historical biases in treatment strategy, protocols and management
  • Takamori et al. themselves noted heterogeneity of patient background and questions about the reasonableness of cut-off values
  • It is unclear how pretreatment CAR should be used in clinical practice

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, Neoplasm, Extrapleural Pneumonectomy (EPP), Chemotherapy, Inflammation, Neoadjuvant Chemotherapy, Histopathology, Performance Status.

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)
• ASO Author Reflections: C-Reactive Protein/Albumin Ratio as a Prognostic Factor in Patients with Malignant Pleural Mesothelioma: What Does the Novel Index Represent? — S. Takamori, M. Takenoyama (2018)
• 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)
• Long-term survival outcomes of cytoreductive surgery and perioperative intraperitoneal chemotherapy: Single-institutional experience with 1225 cases — L.S. Kyang, N.A. Alzahrani, et al. (2019)
• Dose-Dependent Effect of Red Blood Cells Transfusion on Perioperative and Long-Term Outcomes in Peritoneal Surface Malignancies Treated with Cytoreduction and HIPEC — E. Nizri, S. Kusamura, et al. (2018)
• Long-term Survival and Propensity Score Matched Outcomes of Bilateral vs. Unilateral Diaphragm Interventions in Cytoreductive Surgery plus Intra-peritoneal Chemotherapy — B. Singh, G. Singh, et al. (2018)

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