The relationship of C-Reactive Protein to Albumin Ratio and interval debulking surgery outcome after neoadjuvant chemotherapy in ovarian cancer patients

Zheng, Yi; Liu, Shuyu; Chang, Mengran; Wang, Caizhi; Zhou, Yu

doi:10.1016/j.clinsp.2024.100469

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original articles • Clinics 79 • 2024 • https://doi.org/10.1016/j.clinsp.2024.100469 copy

The relationship of C-Reactive Protein to Albumin Ratio and interval debulking surgery outcome after neoadjuvant chemotherapy in ovarian cancer patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To investigate the relationship between the changes of C-reactive protein to Albumin Ratio (CAR) levels and Interval Debulking Surgery (IDS) outcome after Neoadjuvant Chemotherapy (NAC) in ovarian cancer patients.

Methods:

A nested case-control study for 209 patients with ovarian cancer who received NAC-IDS therapy from the First Affiliated Hospital of Bengbu Medical College between 2015‒2021 was conducted. Demographic data, laboratory indicators, and imaging examinations were collected. The outcome was regarded as optimal IDS in this study. Univariate and multivariate logistic regression analyses were performed to assess the relationship of CAR before NAC, CAR after NAC and ΔCAR with optimal IDS. The authors also performed the subgroup analysis based on menopausal state.

Results:

The end time of follow-up was January 24, 2022. A total of 156 patients had been treated with optimal IDS, and 53 with suboptimal IDS. After adjusting age, body mass index, menopausal state, NAC drug, peritoneal perfusion and CAR before NAC, the result showed that CAR after NAC (Odds Ratio [OR = 3.48], 95% Confidence Interval [95% CI 1.28‒9.48], p = 0.015) and ΔCAR (OR = 0.29, 95% CI 0.11‒0.78, p = 0.015) were associated with optimal IDS, respectively. Additionally, the authors found a significant correlation between CAR after NAC and optimal IDS (OR = 3.16, 95% CI 1.07‒9.35, p = 0.038), and ΔCAR and optimal IDS (OR = 0.32, 95% CI 0.11‒0.94, p = 0.038) among ovarian cancer patients with menopause.

Conclusion:

CAR after NAC and ΔCAR were independent prognostic markers of optimal interval debulking surgery for ovarian cancer patients.

Keywords:
C-Reactive Protein; Albumin; Ovarian Cancer; Interval Debulking Surgery; Neoadjuvant Chemotherapy

HIGHLIGHTS

Interval Debulking Surgery (IDS) treats ovarian cancer after neoadjuvant chemotherapy.

Relation between changes of C-reactive protein to Albumin Ratio (CAR) and IDS outcome.

CAR was an independent prognostic marker of optimal IDS for ovarian cancer patients.

Variables	Total (n = 209)	Optimal IDS (n = 156)	Suboptimal IDS (n = 53)	p
Age, years, Mean ± SD	58.71 ± 9.37	58.88 ± 9.07	58.21 ± 10.28	0.654
Height, cm, Mean ± SD	157.87 ± 4.03	158.03 ± 3.81	157.38 ± 4.63	0.308
Weight, kg, Mean ± SD	59.35 ± 8.27	59.38 ± 8.53	59.27 ± 7.56	0.935
BMI, kg/m², Mean ± SD	23.80 ± 3.08	23.76 ± 3.16	23.93 ± 2.87	0.730
Menopausal state, n (%)				0.444
Non-menopause	51 (24.40)	36 (23.08)	15 (28.30)
Menopause	158 (75.60)	120 (76.92)	38 (71.70)
Family history of ovarian cancer, n (%)				0.105
No	204 (97.61)	154 (98.72)	50 (94.34)
Yes	5 (2.39)	2 (1.28)	3 (5.66)
Family history of other cancer, n (%)				0.863
No	21 (10.05)	16 (10.26)	5 (9.43)
Yes	188 (89.95)	140 (89.74)	48 (90.57)
Hypertension, n (%)				0.730
No	158 (75.60)	117 (75.00)	41 (77.36)
Yes	51 (24.40)	39 (25.00)	12 (22.64)
Inflammation, n (%)				0.297
No	198 (94.74)	146 (93.59)	52 (98.11)
Yes	11 (5.26)	10 (6.41)	1 (1.89)
Hemoglobin, g/L, Mean ± SD	121.23 ± 13.20	121.12 ± 13.54	121.55 ± 12.25	0.840
RBC, Mean ± SD	4.27 ± 0.44	4.25 ± 0.43	4.33 ± 0.46	0.222
WBC, Mean ± SD	7.46 ± 2.05	7.49 ± 2.06	7.37 ± 2.02	0.709
PLT, Mean ± SD	387.08 ± 117.92	389.56 ± 122.80	379.75 ± 102.94	0.602
Neutrophil count, 109/L, M (Q1, Q3)	5.17 (3.96, 6.59)	5.31 (4.01, 6.58)	4.85 (3.89, 6.67)	0.423
Lymphocyte count, 109/L, M (Q1, Q3)	1.40 (1.10, 1.81)	1.40 (1.11, 1.80)	1.45 (1.04, 1.82)	0.815
Monocyte count, 109/L, M (Q1, Q3)	0.50 (0.39, 0.62)	0.50 (0.38, 0.62)	0.51 (0.41, 0.61)	0.701
Eosinophils count, 109/L, M (Q1, Q3)	0.08 (0.04, 0.15)	0.08 (0.05, 0.15)	0.07 (0.04, 0.19)	0.495
Basophils count, 109/L, M (Q1, Q3)	0.01 (0.00, 0.02)	0.01 (0.00, 0.02)	0.01 (0.00, 0.02)	0.977
NLR, M (Q1, Q3)	3.73 (2.46, 4.99)	3.63 (2.53, 5.01)	4.02 (2.21, 4.85)	0.959
PLR, M (Q1, Q3)	260.00 (191.35, 359.46)	263.25 (192.10, 357.35)	253.79 (190.91, 365.38)	0.976
RDW, %, Mean ± SD	42.25 ± 3.09	42.04 ± 2.93	42.88 ± 3.47	0.085
MPV, fL, Mean ± SD	10.46 ± 1.11	10.45 ± 1.07	10.47 ± 1.23	0.931
ALT, U/L, M (Q1, Q3)	14.00 (12.00, 17.00)	14.00 (11.00, 17.00)	15.00 (13.00, 18.00)	0.079
AST, U/L, M (Q1, Q3)	21.00 (18.00, 28.00)	21.00 (19.00, 28.00)	23.00 (18.00, 31.00)	0.451
GGT, U/L, M (Q1, Q3)	15.00 (12.00, 22.00)	15.00 (12.00, 22.00)	16.00 (12.00, 23.00)	0.887
ALP, U/L, M (Q1, Q3)	69.00 (57.00, 82.00)	68.00 (56.00, 82.00)	70.00 (58.00, 81.00)	0.757
TBIL, μmoL/L, M (Q1, Q3)	7.20 (5.60, 9.20)	7.25 (5.60, 9.45)	7.20 (5.80, 9.10)	0.905
DBIL, μmoL/L, M (Q1, Q3)	2.50 (1.70, 3.40)	2.60 (1.90, 3.40)	2.10 (1.50, 3.40)	0.131
IBIL, μmoL/L, M (Q1, Q3)	4.60 (3.50, 6.50)	4.55 (3.25, 6.50)	4.90 (3.70, 6.20)	0.348
TP, g/L, Mean ± SD	69.98 ± 7.22	70.03 ± 6.94	69.81 ± 8.05	0.847
GLB, g/L, Mean ± SD	32.07 ± 6.75	31.89 ± 6.21	32.59 ± 8.21	0.568
AGR, Mean ± SD	1.24 ± 0.34	1.25 ± 0.32	1.22 ± 0.40	0.676
BUN, mmoL/L, M (Q1, Q3) Creatinine, μmoL/L, Mean ± SD	4.30 (3.30, 5.56) 60.40 ± 11.65	4.26 (3.30, 5.51) 60.24 ± 11.95	4.40 (3.37, 5.92) 60.87 ± 10.81	0.710 0.737
Uric Acid, μmoL/L, M (Q1, Q3)	271.00 (234.00, 345.00)	267.50 (231.00, 345.00)	298.00 (240.00, 345.00)	0.520
CEA, ng/mL, M (Q1, Q3)	1.31 (0.82, 2.01)	1.29 (0.82, 1.95)	1.35 (0.96, 2.14)	0.223
CA199, IU/mL, M (Q1, Q3)	9.02 (3.59, 21.70)	8.90 (3.55, 20.79)	9.04 (3.60, 29.20)	0.551
CA125, IU/mL, M (Q1, Q3)	1000.00 (652.30, 1617.20)	1000.00 (611.50, 1437.40)	1000.00 (730.00, 1965.20)	0.348
CA153, IU/mL, M (Q1, Q3)	62.07 (28.10, 134.00)	64.82 (29.80, 132.70)	51.20 (23.10, 135.80)	0.533
AFP, IU/mL, M (Q1, Q3)	2.67 (1.85, 3.91)	2.52 (1.81, 3.96)	2.88 (2.07, 3.91)	0.471
NAC drug, n (%)				0.359
Paclitaxel and platinum	72 (34.45)	51 (32.69)	21 (39.62)
Docetaxel and platinum	137 (65.55)	105 (67.31)	32 (60.38)
Peritoneal perfusion				0.787
Yes	19 (9.09)	15 (9.62)	4 (7.55)
No	190 (90.91)	141 (90.38)	49 (92.45)
NAC Cycle, M (Q1, Q3)	2.00 (2.00, 3.00)	2.00 (2.00, 3.00)	2.00 (2.00, 3.00)	0.832
ALB before NAC, g/L, Mean ± SD	37.90 ± 4.57	38.13 ± 4.47	37.21 ± 4.84	0.206
ALB after NAC, g/L, Mean ± SD	41.74 ± 4.27	42.14 ± 3.84	40.55 ± 5.20	0.044
CRP before NAC, mg/L, M (Q1, Q3)	39.60 (13.20, 71.40)	39.95 (14.44, 91.35)	38.02 (10.50, 55.00)	0.333
CRP after NAC, mg/L, M (Q1, Q3)	2.40 (1.20, 5.50)	2.08 (1.20, 5.00)	3.20 (1.60, 9.00)	0.059
CAR before NAC, M (Q1, Q3)	1.00 (0.33, 2.14)	1.02 (0.36, 2.38)	0.88 (0.28, 1.49)	0.402
CAR after NAC, M (Q1, Q3)	0.06 (0.03, 0.14)	0.05 (0.03, 0.12)	0.07 (0.04, 0.20)	0.053
ΔCAR, M (Q1, Q3)	0.90 (0.19, 1.94)	0.96 (0.22, 2.33)	0.56 (0.16, 1.39)	0.079
FIGO staging, n (%)				<0.001
I	17 (8.13)	17 (10.90)	0 (0.00)
II	26 (12.44)	23 (14.74)	3 (5.66)
III	152 (72.73)	115 (73.72)	37 (69.81)
IV	14 (6.70)	1 (0.64)	13 (24.53)
Grade staging, n (%)				0.165
Well-differentiated	7 (3.35)	5 (3.21)	2 (3.77)
Moderately-differentiated	11 (5.26)	10 (6.41)	1 (1.89)
Intermediate between well-differentiated and moderately differentiated	13 (6.22)	8 (5.13)	5 (9.43)
Poorly-differentiated	127 (60.77)	90 (57.69)	37 (69.81)
Unknown	51 (24.40)	43 (27.56)	8 (15.09)
Histology, n (%)				0.268
Serous cystadenocarcinoma	139 (66.51)	103 (66.03)	36 (67.92)
Non-serous adenocarcinoma	52 (24.88)	37 (23.72)	15 (28.30)
Unknown	18 (8.61)	16 (10.26)	2 (3.77)

Variables	Model 1		Model 2		Model 3
Variables	OR (95% CI)	p	OR (95% CI)	p	OR (95% CI)	p
CAR before NAC	0.87 (0.70‒1.07)	0.175	0.86 (0.69‒1.06)	0.151	–	–
CAR after NAC	2.69 (1.10‒6.60)	0.030	3.00 (1.18‒7.63)	0.021	3.48 (1.28‒9.48)	0.015
ΔCAR	0.80 (0.65‒0.99)	0.046	0.79 (0.63‒0.99)	0.037	0.29 (0.11‒0.78)	0.015

Variables	OR (95% CI)	p
Non-menopause (n = 51)
CAR before NAC^a a Adjusted age, body mass index, menopausal state, NAC drug and peritoneal perfusion.	0.96 (0.65‒1.40)	0.820
CAR after NAC^b b Adjusted age, body mass index, menopausal state, NAC drug, peritoneal perfusion and CAR before NAC.	5.18 (0.21‒125.31)	0.311
ΔCAR^b b Adjusted age, body mass index, menopausal state, NAC drug, peritoneal perfusion and CAR before NAC.	0.19 (0.01‒4.66)	0.311
Menopause (n = 158)
CAR before NAC^a a Adjusted age, body mass index, menopausal state, NAC drug and peritoneal perfusion.	0.81 (0.61‒1.06)	0.129
CAR after NAC^b b Adjusted age, body mass index, menopausal state, NAC drug, peritoneal perfusion and CAR before NAC.	3.16 (1.07‒9.35)	0.038
ΔCAR^b b Adjusted age, body mass index, menopausal state, NAC drug, peritoneal perfusion and CAR before NAC.	0.32 (0.11‒0.94)	0.038

Faculdade de Medicina / USP Rua Dr Ovídio Pires de Campos, 225 - 6 and., 05403-010 São Paulo SP - Brazil, Tel.: (55 11) 2661-6235 - São Paulo - SP - Brazil
E-mail: clinics@hc.fm.usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author. E-mail address:yuzhoudct@163.com (Y. Zhou).