Correlation Analysis Of Preoperative CRP/Alb And P-CRP In The Prognosis Of Patients With Locally Advanced Colorectal Cancer

BACKGROUND:Studies have shown that inflammation is closely related to malignant tumors.In most cases,malignant tumors are associated with local or systemic inflammatory responses.Neutrophils,white blood cells,lymphocytes,platelets,C-reactive protein,plasma albumin,pre-albumin,and anterior inflammatory indicators such as albumin and interleukin-6 reflect the inflammatory state of cancer patients;Neutrophil-to-lymphocyte ratio?NLR?,Platelet-to-lymphocyte ratio?PLR?,Glasgow Prognostic Score?GPS?and modify Glasgow Prognostic Score?mGPS?and other inflammatory-based prognostic scores have predictive value for the prognosis of a variety of cancers including gastric cancer,colorectal cancer,etc.CRP has long been used for prognosis evaluation of patients with malignant tumors and has a wide range of clinical applications.The C-reactive protein/albumin?CRP/Alb?ratio is associated with prognosis in patients with sepsis and has recently been shown to be closely associated with the prognosis of malignant tumors such as cervical,ovarian and pancreatic cancer.Platelet and C-reactive protein multiplication ?P-CRP?as a new prognostic indicator,has recently been proved to have high clinical value for the prognosis of malignant tumors such as pancreatic cancer.The above two indicators based on CRP are used as the prognostic score based on inflammation,and the evaluation of the prognosis of patients with locally advanced colorectal cancer is relatively rare at home and abroad.Objective:This study retrospectively investigated the prognostic significance of two C-reactive protein-based inflammatory markers,the preoperative platelet×C-reactive protein multiplier value?P-CRP?and the preoperative C-reactive protein/albumin ratio?CRP/Alb?in patients with locally advanced colorectal cancer.Analyze the relationship between the above two inflammation indicators and clinicopathological data.It is hoped to provide a simple index for clinical work to early evaluate the postoperative prognosis of patients with colorectal cancer.Methods:324 patients with pathologically certified locally advanced colorectal cancer underwent surgery at the Affiliated Hospital of Southwest Medical University between January 2013 and January 2015 were retrospectively reviewed.All patients were followed for 5 years at least or until death,and the follow-up deadline was January 2020.Collect patients data: gender,age,clinical stage,tumor diameter,tumor location,depth of invasion,vascular invasion,lymph node metastasis,differentiation,survival time,surgical approach,Preoperative hematologic parameters:C-reactive protein,serum albumin,platelets,and calculate the ratio of C-reactive protein/albumin?CRP/Alb?and the product of platelet and C-reactive protein?P-CRP?.The receiver operating characteristic curve?ROC?is plotted and the corresponding optimal intercept point is obtained according to the Youden index.According to the best cut-off point,patients were divided into high-level group and low-level group with corresponding indicators,and the corresponding statistical comparison was performed.Take C-reactive protein/albumin?CRP/Alb?=0.85as the cut-off point,CRP/Alb?0.85 for the CRP/Alb^Highigh group?n=132?,and CRP/Alb<0.85 for the CRP/Alb^Lowow group?n=192?;the product of platelet and C-reactive protein?P-CRP?=7.62 was used as the demarcation point,P-CRP?7.62 was the P-CRP^Highigh group?n=134?,and P-CRP<7.62 was the P-CRP^Lowow group?n=190?.The overall survival rate and the relationship between CRP/Alb and P-CRP and clinicopathological variables of the two groups were compared,and the factors that influence 5-year survival rate of locally advanced colorectal cancer were analyzed by univariate and multivariate analysis.The differences between groups were compared using chi-square test or Fisher exact probability method.The area under the curve?AUC?was compared using MedCalc 15.2.1.Overall survival?OS?was evaluated by the Kaplan–Meier method and Log-Rank test.The multivariate analysis of risk factors for overall survival was evaluated with the Cox proportional hazards model.Results:CRP/Alb was correlated significantly with age,tumor size,differentiation,depth of invasion,lymph node metastasis and clinical stage ?P<0.05?,while P-CRP was related significantly to tumor size,differentiation,depth,lymph node metastasis,venous involvement and stage?P<0.05?.The best cutoff values for CRP,Alb,and PLT were 29.01,31.90,and 262.50, respectively.The 5-year survival rate was lower in patients with low-albumin before surgery??²=10.347,P=0.001?;in patients with high CRP levels,cancer patients five-year survival rate decreased??²=9.289,P=0.002?;5-year survival rate of patients with high platelet count decreased after operation??²=4.863,P=0.027?.In the ROC analysis,the best cut-off value for CRP/Alb and P-CRP was 0.85 and 7.62,respectively.The 5-year survival rate in the CRP/Alb^High group was worse than the CRP/Alb^Lowow group??²=11.902,P=0.001?.The 5-year survival rate in the P-CRP^Highigh group was worse than the P-CRP^Lowow group ??²=7.103,P=0.008?.In terms of overall survival and disease-specific survival rate,the prognosis of patients with CRP/Alb^High/P-CRP^Highigh was significantly worse than that of CRP/Alb^Highigh or P-CRP^High??²=4.738,P=0.029?and CRP/Alb^Low/P-CRP^Lowow groups??²=18.618,P=0.000?,CRP/Alb^Highigh or P-CRP^Highigh groups lower than that of CRP/Alb ^Low/P-CRP^Low??²=4.971,P=0.026?.Univariate analysis showed that age,tumor size,differentiation,depth of invasion,venous involvement,clinical stage,lymph node metastasis,CRP,PLT,Alb,preoperative CRP/Alb and P-CRP were risk factors for patients with locally advanced colorectal cancer.Multivariate analysis suggested that age,differentiation,lymph node metastasis,venous invasion,clinical stage,CRP,PLT,Alb,preoperative CRP/Alb and P-CRP were independent risk factors.Z-test showed that CRP/Alb and P-CRP were superior to CRP,Alb and PLT in terms of prognostic significance?P<0.05?.Conclusion:Univariate analysis showed that differentiation,depth of invasion,clinical stage,lymph node metastasis,venous involvement,CRP and Alb,etc were risk factors for the 5-year survival rate of colorectal cancer.Multivariate analysis suggested that age,differentiation,clinical stage,PLT,etc were independent risk factors for the prognosis of locally advanced colorectal cancer.CRP/Alb and P-CRP could be used as evaluation index of prognosis for patients with locally advanced colorectal cancer.While at the cutoff values of0.85 and 7.62,they are independent prognostic factors for patients with locally advanced colorectal cancer.