Prognostic role of the pretreatment C-reactive protein/albumin ratio in gastric cancer A systematic review and meta-analysis

Background: In recent years, several studies have investigated the prognostic role of the pretreatment C-reactive protein/albumin ratio (CAR) in gastric cancer and yielded conflicting results. Therefore, we performed a meta-analysis to assess the prognostic role of the pretreatment CAR in gastric cancer. Methods: Studies assessing the prognostic role of the pretreatment CAR in patients with gastric cancer were searched from PubMed, Embase, and Cochrane Library up to June 6, 2019. Pooled hazard ratios (HRs) for overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) were estimated using a fixed-effects model. Results: Eight observational studies including 3102 patients were enrolled in this meta-analysis. The pooled result showed that patients with a high CAR had worse OS (pooled HR = 1.87; 95% confidence interval (CI) = 1.55-2.26; P < .001). Results from subgroup analyses indicated that patient country, adjuvant chemotherapy rate, and CAR cut-off value could not affected the property of the correlation (P < .001). However, the intensity of the correlation was affected by these factors. In addition, patients with a high CAR had significantly worse RFS (pooled HR = 2.11; 95% CI = 1.41-3.15; P < .001) and CSS (HR = 1.59; 95% CI = 1.08-2.35; P = .019). Conclusion: A high pretreatment CAR was significantly associated with poor survival for patients with gastric cancer. The prognostic significance of the pretreatment CAR in gastric cancer is need to be confirmed by clinical trials of large sample size.