{"title":"c反应蛋白（CRP）和基于白蛋白的生物标志物在乳腺癌化疗患者中的预后意义","authors":"Susanna Hilda Hutajulu, Yufi Kartika Astari, Meita Ucche, Nyoman Kertia, Yanri Wijayanti Subronto, Dewi Kartikawati Paramita, Lina Choridah, Ericko Ekaputra, Irianiwati Widodo, Suwardjo Suwardjo, Mardiah Suci Hardianti, Kartika Widayati Taroeno-Hariadi, Ibnu Purwanto, Johan Kurnianda","doi":"10.7717/peerj.19319","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Breast cancer patients with similar clinicopathologic characteristics may experience varied outcomes. This urges an increased effort to investigate other prognostic factors. C-reactive protein (CRP)-to-albumin ratio (CAR) is an inflammatory and nutritional biomarker that has been well studied and reported to have an impact on the survival of patients with diverse types of cancer, but limitedly in breast cancer. Therefore, this study aimed to investigate the prognostic significance of CAR in local patients with breast cancer.</p><p><strong>Methods: </strong>This study included 202 stage I-IV breast cancer patients receiving first-line chemotherapy. We calculated inflammatory and nutritional biomarkers including CAR, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), pan-immune-inflammation value (PIV), and prognostic nutrition index (PNI) before treatment. The Kaplan-Meier with log-rank test and Cox proportional hazard regression were used to analyze the prognostic role of clinicopathologic factors and biomarkers on disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS).</p><p><strong>Results: </strong>The median follow-up period was 46 months (1-77 months). The 3-year DFS and 3-year OS in patients with high CAR (CAR > 1.5) were significantly lower than those with low CAR (CAR ≤ 1.5) (47.0% <i>vs</i> 68.9%, <i>P</i> = 0.022 and 59.5% <i>vs</i> 78.6%, <i>P</i> = 0.009, respectively). Multivariate analysis showed high CAR as prognostic factors for poor DFS (HR 2.10, 95% confidence interval/CI [1.10-3.99], <i>P</i> = 0.023) and OS (HR 2.16, 95% CI [1.27-3.68], <i>P</i> = 0.005), but not for PFS (HR 1.43, 95% CI [0.73-2.80], <i>P</i> = 0.293). In addition, more advanced stage and HER2 positive were correlated with unfavorable DFS and OS, older age predicted poor DFS, and stage was the only prognostic factor of PFS (all <i>P</i> values < 0.05).</p><p><strong>Conclusion: </strong>Besides age, stage, and molecular subtypes that have been widely observed to have impact on the survival of breast cancer patients, CAR was demonstrated as a promising prognostic marker in our local patients. A high CAR at diagnosis was associated with unfavorable DFS and OS, which can aid in identifying patients at risk and guide personalized treatment planning.</p>","PeriodicalId":19799,"journal":{"name":"PeerJ","volume":"13 ","pages":"e19319"},"PeriodicalIF":2.3000,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103165/pdf/","citationCount":"0","resultStr":"{\"title\":\"Prognostic significance of C-reactive protein (CRP) and albumin-based biomarker in patients with breast cancer receiving chemotherapy.\",\"authors\":\"Susanna Hilda Hutajulu, Yufi Kartika Astari, Meita Ucche, Nyoman Kertia, Yanri Wijayanti Subronto, Dewi Kartikawati Paramita, Lina Choridah, Ericko Ekaputra, Irianiwati Widodo, Suwardjo Suwardjo, Mardiah Suci Hardianti, Kartika Widayati Taroeno-Hariadi, Ibnu Purwanto, Johan Kurnianda\",\"doi\":\"10.7717/peerj.19319\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Breast cancer patients with similar clinicopathologic characteristics may experience varied outcomes. This urges an increased effort to investigate other prognostic factors. C-reactive protein (CRP)-to-albumin ratio (CAR) is an inflammatory and nutritional biomarker that has been well studied and reported to have an impact on the survival of patients with diverse types of cancer, but limitedly in breast cancer. Therefore, this study aimed to investigate the prognostic significance of CAR in local patients with breast cancer.</p><p><strong>Methods: </strong>This study included 202 stage I-IV breast cancer patients receiving first-line chemotherapy. We calculated inflammatory and nutritional biomarkers including CAR, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), pan-immune-inflammation value (PIV), and prognostic nutrition index (PNI) before treatment. The Kaplan-Meier with log-rank test and Cox proportional hazard regression were used to analyze the prognostic role of clinicopathologic factors and biomarkers on disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS).</p><p><strong>Results: </strong>The median follow-up period was 46 months (1-77 months). The 3-year DFS and 3-year OS in patients with high CAR (CAR > 1.5) were significantly lower than those with low CAR (CAR ≤ 1.5) (47.0% <i>vs</i> 68.9%, <i>P</i> = 0.022 and 59.5% <i>vs</i> 78.6%, <i>P</i> = 0.009, respectively). Multivariate analysis showed high CAR as prognostic factors for poor DFS (HR 2.10, 95% confidence interval/CI [1.10-3.99], <i>P</i> = 0.023) and OS (HR 2.16, 95% CI [1.27-3.68], <i>P</i> = 0.005), but not for PFS (HR 1.43, 95% CI [0.73-2.80], <i>P</i> = 0.293). In addition, more advanced stage and HER2 positive were correlated with unfavorable DFS and OS, older age predicted poor DFS, and stage was the only prognostic factor of PFS (all <i>P</i> values < 0.05).</p><p><strong>Conclusion: </strong>Besides age, stage, and molecular subtypes that have been widely observed to have impact on the survival of breast cancer patients, CAR was demonstrated as a promising prognostic marker in our local patients. A high CAR at diagnosis was associated with unfavorable DFS and OS, which can aid in identifying patients at risk and guide personalized treatment planning.</p>\",\"PeriodicalId\":19799,\"journal\":{\"name\":\"PeerJ\",\"volume\":\"13 \",\"pages\":\"e19319\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-05-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103165/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"PeerJ\",\"FirstCategoryId\":\"99\",\"ListUrlMain\":\"https://doi.org/10.7717/peerj.19319\",\"RegionNum\":3,\"RegionCategory\":\"生物学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"MULTIDISCIPLINARY SCIENCES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"PeerJ","FirstCategoryId":"99","ListUrlMain":"https://doi.org/10.7717/peerj.19319","RegionNum":3,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"MULTIDISCIPLINARY SCIENCES","Score":null,"Total":0}
引用次数: 0
摘要
背景：具有相似临床病理特征的乳腺癌患者可能经历不同的结局。这促使我们加大对其他预后因素的研究力度。c反应蛋白（CRP）与白蛋白比（CAR）是一种炎症和营养生物标志物，已被充分研究并报道对不同类型癌症患者的生存有影响，但仅限于乳腺癌。因此，本研究旨在探讨CAR在局部乳腺癌患者中的预后意义。方法：本研究纳入202例接受一线化疗的I-IV期乳腺癌患者。我们计算了治疗前的炎症和营养生物标志物，包括CAR、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、淋巴细胞与单核细胞比值（LMR）、全身免疫炎症指数（SII）、全身炎症反应指数（SIRI）、泛免疫炎症值（PIV）和预后营养指数（PNI）。采用Kaplan-Meier log-rank检验和Cox比例风险回归分析临床病理因素和生物标志物对无病生存期（DFS）、无进展生存期（PFS）和总生存期（OS）的预后作用。结果：中位随访时间为46个月（1 ~ 77个月）。CAR高（CAR > 1.5）患者的3年DFS和3年OS显著低于CAR低（CAR≤1.5）患者（分别为47.0%比68.9%,P = 0.022和59.5%比78.6%,P = 0.009）。多因素分析显示，高CAR是不良DFS （HR 2.10, 95%可信区间/CI [1.10-3.99], P = 0.023）和OS （HR 2.16, 95% CI [1.27-3.68], P = 0.005）的预后因素，但非PFS （HR 1.43, 95% CI [0.73-2.80], P = 0.293）的预后因素。此外，越晚期和HER2阳性与不良的DFS和OS相关，年龄越大预测不良的DFS，分期是PFS的唯一预后因素（P值均< 0.05）。结论：除了年龄、分期和分子亚型已被广泛观察到对乳腺癌患者生存有影响外，CAR被证明是一种有希望的乳腺癌患者预后标志物。诊断时的高CAR与不利的DFS和OS相关，这有助于识别有风险的患者并指导个性化的治疗计划。
Prognostic significance of C-reactive protein (CRP) and albumin-based biomarker in patients with breast cancer receiving chemotherapy.
Background: Breast cancer patients with similar clinicopathologic characteristics may experience varied outcomes. This urges an increased effort to investigate other prognostic factors. C-reactive protein (CRP)-to-albumin ratio (CAR) is an inflammatory and nutritional biomarker that has been well studied and reported to have an impact on the survival of patients with diverse types of cancer, but limitedly in breast cancer. Therefore, this study aimed to investigate the prognostic significance of CAR in local patients with breast cancer.
Methods: This study included 202 stage I-IV breast cancer patients receiving first-line chemotherapy. We calculated inflammatory and nutritional biomarkers including CAR, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), pan-immune-inflammation value (PIV), and prognostic nutrition index (PNI) before treatment. The Kaplan-Meier with log-rank test and Cox proportional hazard regression were used to analyze the prognostic role of clinicopathologic factors and biomarkers on disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS).
Results: The median follow-up period was 46 months (1-77 months). The 3-year DFS and 3-year OS in patients with high CAR (CAR > 1.5) were significantly lower than those with low CAR (CAR ≤ 1.5) (47.0% vs 68.9%, P = 0.022 and 59.5% vs 78.6%, P = 0.009, respectively). Multivariate analysis showed high CAR as prognostic factors for poor DFS (HR 2.10, 95% confidence interval/CI [1.10-3.99], P = 0.023) and OS (HR 2.16, 95% CI [1.27-3.68], P = 0.005), but not for PFS (HR 1.43, 95% CI [0.73-2.80], P = 0.293). In addition, more advanced stage and HER2 positive were correlated with unfavorable DFS and OS, older age predicted poor DFS, and stage was the only prognostic factor of PFS (all P values < 0.05).
Conclusion: Besides age, stage, and molecular subtypes that have been widely observed to have impact on the survival of breast cancer patients, CAR was demonstrated as a promising prognostic marker in our local patients. A high CAR at diagnosis was associated with unfavorable DFS and OS, which can aid in identifying patients at risk and guide personalized treatment planning.
期刊介绍：
PeerJ is an open access peer-reviewed scientific journal covering research in the biological and medical sciences. At PeerJ, authors take out a lifetime publication plan (for as little as $99) which allows them to publish articles in the journal for free, forever. PeerJ has 5 Nobel Prize Winners on the Board; they have won several industry and media awards; and they are widely recognized as being one of the most interesting recent developments in academic publishing.
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