The prognostic value of C-reactive protein/albumin ratio in human malignancies: an updated meta-analysis

Purpose: This study aims to investigate the prognostic value of pretreatment C-reactive protein/albumin ratio (CAR) in human malignancies by an updated meta-analysis. Methods: PubMed, Web of Science, Cochrane Library and Wanfang databases were searched. Pooled hazard ratios (HRs) and odds ratios (ORs) with their corresponding 95% confidence intervals (CIs) were used as effective values. Results: A total of 25 studies with 12,097 patients were included in this meta-analysis. Pooled results showed that high pretreatment CAR was associated with poor overall survival (OS) (HR = 1.99, 95% CI: 1.65-2.40, P= 0.000) and poor disease-free survival (HR = 1.55, 95% CI: 1.34-1.79, P= 0.000). In addition, high pretreatment CAR was associated with increased 5-year mortality (OR = 2.74, 95% CI: 2.11-3.55, P= 0.000). Moreover, subgroup analysis demonstrated that high CAR was associated with poor OS despite variations in publication year, country, sample size, CAR cut-off value and treatment. However, high CAR was associated with poor OS in human malignancies except colorectal cancer (HR = 1.64, 95% CI: 0.96-2.80, P= 0.069). Conclusion: High pretreatment CAR indicates poor prognosis in human malignancies except colorectal cancer. Thus, pretreatment CAR serves as a prognostic marker in human malignancies and could be used in the evaluation of prognosis in clinical work.