Prognostic value of the C-reactive protein to albumin ratio: a novel inflammation-based prognostic indicator in osteosarcoma

The prognostic role of the C-reactive protein to albumin ratio (CRP/Alb ratio) in patients with osteosarcoma has not been investigated. A total of 216 osteosarcoma patients were enrolled in the study. Univariate and multivariate survival analyses between the groups were performed and Kaplan-Meier analysis was conducted to plot the survival curves. Receiver operating characteristic curves were generated and areas under the curve (AUCs) were compared to assess the discriminatory ability of the inflammation-based indicators, including CRP/Alb ratio, Glasgow prognostic score (GPS), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR). The optimal cutoff value was 0.210 for CRP/Alb ratio with a Youden index of 0.319. Higher values of CRP/Alb ratio were significantly associated with poorer overall survival in univariate (HR = 2.62, 95% CI = 1.70-4.03; P < 0.001) and multivariate (HR = 2.21, 95% CI = 1.40-3.49; P=0.001) analyses. In addition, the CRP/Alb ratio had significantly higher AUC values compared with GPS (P=0.003), NLR (P < 0.001), and PLR (P < 0.001). The study demonstrated that the CRP/Alb ratio is an effective inflammation-based prognostic indicator in osteosarcoma, which potentially has a discriminatory ability superior to that of other inflammatory indicators including GPS, NLR, and PLR.