C-reactive protein to albumin ratio predict responses to programmed cell death-1 inhibitors in hepatocellular carcinoma patients

doi:10.4251/wjgo.v16.i1.61

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Oncol. Jan 15, 2024; 16(1): 61-78
Published online Jan 15, 2024. doi: 10.4251/wjgo.v16.i1.61

Table 1 The correlations between the C-reactive protein to albumin ratio and clinicopathological factors, n (%)

	CAR ≤ 1.20 (n = 94)	CAR > 1.20 (n = 66)	Total (n = 160)	P value
Age (yr)				0.143
≤ 60	75 (79.8)	46 (69.7)	121 (75.6)
> 60	19 (20.2)	20 (30.3)	39 (24.4)
Gender				0.045
Male	77 (81.9)	57 (86.4)	134 (83.8)
Female	17 (18.1)	9 (13.6)	26 (16.3)
Hepatitis infection				0.988
No	17 (18.1)	12 (18.2)	29 (18.1)
Yes	77 (81.9)	54 (81.8)	131 (81.9)
Child-Pugh grade				0.749
A	75 (79.8)	54 (81.8)	129 (80.6)
B	19 (21.2)	12 (18.2)	31 (19.4)
AFP level (ng/L)				0.365
≤ 400	58 (61.7)	36 (54.5)	94 (58.8)
> 400	36 (38.3)	30 (45.5)	66 (41.3)
ECOG PS				0.990
0	30 (31.9)	21 (31.8)	51 (31.9)
≥ 1	64 (68.1)	45 (68.2)	109 (68.1)
Tumor size (cm)				0.248
≤ 5	26 (27.7)	13 (19.7)	39 (24.4)
> 5	68 (72.3)	53 (80.3)	121 (75.6)
Tumor number				0.512
Single	18 (19.1)	10 (15.2)	28 (17.5)
Multiple	76 (80.9)	56 (84.8)	132 (82.5)
Macroscopic vascular invasion				0.013
Absent	60 (63.8)	29 (43.9)	89 (55.6)
Present	34 (36.2)	37 (56.1)	71 (44.4)
Extrahepatic metastasis				0.173
Absent	41 (43.6)	36 (54.5)	77 (48.1)
Present	53 (56.4)	30 (45.5)	83 (51.9)
Diabetes				0.955
No	84 (89.4)	59 (89.4)	143 (89.4)
Yes	10 (10.6)	7 (10.6)	17 (10.6)
Hypertension				0.455
No	81 (86.2)	54 (81.8)	135 (84.4)
Yes	13 (13.8)	12 (18.2)	25 (15.6)
Smoke				0.013
No	60 (63.8)	29 (43.9)	89 (55.6)
Yes	34 (36.2)	37 (56.1)	71 (44.4)
Drink				0.364
No	51 (54.3)	31 (47.0)	82 (51.2)
Yes	43 (45.7)	35 (53.0)	78 (48.8)
Cirrhosis				0.191
No	40 (42.6)	35 (53.0)	75 (46.9)
Yes	54 (57.4)	31 (47.0)	85 (53.1)
Previous Ablation				0.119
No	87 (92.6)	56 (84.8)	143 (89.4)
Yes	7 (7.4)	10 (15.2)	17 (10.6)
Previous TACE				0.505
No	52 (55.3)	40 (60.6)	92 (57.)
Yes	42 (44.7)	26 (39.4)	68 (42.5)
Previous Surgery				0.701
No	57 (60.6)	42 (63.6)	99 (61.9)
Yes	37 (39.4)	24 (36.4)	61 (38.1)
BCLC stage				0.966
A	6 (6.4)	4 (6.1)	10 (6.3)
B	17 (18.1)	13 (19.7)	30 (18.8)
C	71 (75.5)	49 (74.2)	120 (75.0)

AFP: Alpha-fetoprotein; ECOG PS: Eastern Cooperative Oncology Group performance status; CAR: C-reactive protein to albumin ratio; TACE: Transcatheter arterial chemoembolization; BCLC: Barcelona Clinic Liver Cancer.

Table 2 Univariate and multivariate Cox regression analyses of risk factors for overall survival

	UnivariateHR (95%CI)	P value	MultivariateHR (95%CI)	P value
Age (yr)
≤ 60	1.0
> 60	1.222 (0.763-1.958)	0.403
Gender
Male	1.0
Female	1.127 (0.669-1.898)	0.653
Aetiology
Other	1.0
Viral hepatitis	1.464 (0.810-2.646)	0.207
ECOG PS
0	1.0
≥ 1	2.010 (1.229-3.288)	0.005	1.754 (1.045-2.944)	0.033
Child-Pugh grade
A	1.0
B	1.348 (0.798-2.276)	0.264
AFP (ng/mL)
≤ 400	1.0
> 400	1.401 (0.920-2.133)	0.116
PIVKA-II (mAU/mL)
≤ 100	1.0
> 100	1.942 (1.142-3.302)	0.014
CAR
≤ 1.20	1.0
> 1.20	2.264 (1.480-3.464)	0.000	2.118 (1.057-4.243)	0.034
Tumor size (cm)
≤ 5	1.0
> 5	2.671 (1.451-4.971)	0.002
Tumor number
Single	1.0
Multiple	3.328 (1.452-7.682)	0.004	2.932 (1.246-6.897)	0.014
Extrahepatic metastasis
-	1.0
+	1.121 (0.735-1.709)	0.597
Macrovascular invasion
-	1.0
+	1.550 (1.015-2.367)	0.042
Diabetes
No	1.0
Yes	0.934 (0.467-1.868)	0.848
Hypertension
No	1.0
Yes	0.902 (0.508-1.602)	0.726
Smoke
No	1.0
Yes	1.634 (1.068-2.501)	0.024
Drink
No	1.0
Yes	1.386 (0.911-2.111)	0.128
Cirrhosis
No	1.0
Yes	0.899 (0.589-1.372)	0.622
Previous TACE
No	1.0
Yes	0.897 (0.587-1.371)	0.615
Previous ablation
No	1.0
Yes	0.719 (0.346-1.497)	0.378
Previous operation
No	1.0
Yes	0.555 (0.351-0.878)	0.012
CRP (mg/L)	1.008 (1.002-1.014)	0.005
ALB (g/L)	0.944 (0.902-0.988)	0.013
AST (U/L)	1.006 (1.003-1.010)	0.000
ALT (U/L)	1.004 (0.998-1.011)	0.219
PLR	0.999 (0.997-1.002)	0.562
LCR	0.771 (0.065-9.087)	0.836
NLR	1.036 (0.953-1.126)	0.410

ECOG PS: Eastern Cooperative Oncology Group Performance Status; AFP: Alpha-fetoprotein; PIVKA-II: Protein induced by vitamin K absence II; CAR: C-reactive protein to albumin ratio; HR: Hazard ratio; 95%CI: 95% confidence interval; TACE: Transcatheter arterial chemoembolization; CRP: C-reactive protein; ALB: Albumin; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; PLR: Platelet to lymphocyte ratio; LCR: Lymphocyte-C reactive protein ratio; NLR: Neutrophil to lymphocyte ratio.

Table 3 Univariate and multivariate Cox regression analyses of risk factors for progression free survival.

	UnivariateHR (95%CI)	P value	MultivariateHR (95%CI)	P value
Age (yr)
≤ 60	1.0
> 60	1.036 (0.706-1.521)	0.856
Gender
Male	1.0
Female	1.181 (0.765-1.824)	0.453
Aetiology
Other	1.0
Viral hepatitis	1.535 (0.962-2.450)	0.072
ECOG PS
0	1.0
≥ 1	1.258 (0.881-1.797)	0.206
Child-Pugh grade
A	1.0
B	1.430 (0.926-2.208)	0.106
AFP (ng/mL)
≤ 400	1.0
> 400	1.321 (0.943-1.849)	0.105
PIVKA-II (mAU/mL)
≤ 100	1.0
> 100	1.013 (0.698-1.471)	0.944
CAR
≤ 1.20	1.0
> 1.20	3.467 (2.342-5.132)	0.000	2.730 (1.502-4.961)	0.001
Tumor size (cm)
≤ 5	1.0
> 5	1.295 (0.882-1.901)	0.188
Tumor number
Single	1.0
Multiple	1.653 (1.054-2.591)	0.028	1.584 (1.003-2.500)	0.048
Extrahepatic metastasis
-	1.0
+	1.154 (0.827-1.609)	0.400
Macrovascular invasion
-	1.0
+	1.083 (0.774-1.514)	0.642
Diabetes
No	1.0
Yes	0.967 (0.573-1.632)	0.900
Hypertension
No	1.0
Yes	0.969 (0.613-1.530)	0.892
Smoke
No	1.0
Yes	1.349 (0.962-1.892)	0.082
Drink
No	1.0
Yes	1.091 (0.781-1.524)	0.609
Cirrhosis
No	1.0
Yes	1.169 (0.837-1.632)	0.360
Previous TACE
No	1.0
Yes	0.905 (0.646-1.267)	0.561
Previous ablation
No	1.0
Yes	1.361 (0.806-2.297)	0.249
Previous operation
No	1.0
Yes	1.143 (0.812-1.609)	0.442
CRP (mg/L)	1.014 (1.008-1.019)	0.000
ALB (g/L)	0.950 (0.918-0.983)	0.004
AST (U/L)	1.001 (0.997-1.004)	0.771
ALT (U/L)	0.999 (0.993-1.005)	0.643
PLR	1.000 (0.998-1.002)	0.733
LCR	0.064 (0.006-0.722)	0.026
NLR	1.092 (1.006-1.186)	0.036	1.120 (1.022-1.228)	0.015

Citation: Li BB, Chen LJ, Lu SL, Lei B, Yu GL, Yu SP. C-reactive protein to albumin ratio predict responses to programmed cell death-1 inhibitors in hepatocellular carcinoma patients. World J Gastrointest Oncol 2024; 16(1): 61-78
URL: https://www.wjgnet.com/1948-5204/full/v16/i1/61.htm
DOI: https://dx.doi.org/10.4251/wjgo.v16.i1.61