Objective : Exploring the expression characteristics of CRP/ALB (CAR) in DLBCL patients and its value in prognostic judgment. Methods: We collected the basic information, clinical characteristics, laboratory examinations and follow-up prognosis of 142 newly diagnosed DLBCL patients with relatively complete data in our hospital and performed statistical analysis. We used X-tile analysis software to obtain the best cut-off value of CAR (0.33), compared the clinical characteristics and survival of patients in the high CAR group and the low CAR group, and compared the survival status with the IPI scoring system. Results: 1) There were significant differences in staging, grouping, IPI scores, extranodal involvement, LDH levels, β 2-microglobulin, CA125, and Hb levels between the high CAR group and the low CAR group (all P < 0.05). 2) According to the survival curve, the OS of the high CAR group was significantly shorter than that of the low CAR group ( P < 0.01), and the one-year, three-year and five-year survival conditions of high CAR group were all shorter than those of low CAR group. 3) COX analysis showed that high CAR is an independent poor prognostic factor for DLBCL patients. 4) A comparative analysis of OS, three-year and five-year survival showed that the combination of CAR and IPI was significantly better than the IPI system, and there was no significant difference in the evaluation value of the prognosis between CAR alone and IPI alone. Conclusion: High CAR value, like the IPI scoring system, is an independent poor prognostic factor of DLBCL, can be used as a reliable indicator of prognosis. And CAR can also be combined with IPI to evaluate the prognosis of DLBCL, of which the effect is better than that of IPI alone.
KeywordsDLBCLCRP/ALBIPIPrognosisSignificance
Swerdlow, S.H., Campo, E., Pileri, S.A., et al. (2016) The 2016 Revision of the World Health Organization Classification of Lymphoid Neoplasms. Blood, 127, 2375-2390. https://doi.org/10.1182/blood-2016-01-643569
Zhou, Z., Sehn, L.H., Rademaker, A.W., et al. (2014) An Enhanced International Prognostic Index (NCCN-IPI) for Patients with Diffuse Large B-Cell Lymphoma Treated in the Rituximab Era. Blood, 123, 837-842. https://doi.org/10.1182/blood-2013-09-524108
Joffe, L., Dwyer, S., Glade Bender, J.L., et al. (2019) Nutritional Status and Clinical Outcomes in Pediatric Patients with Solid Tumors: A Systematic Review of the Literature. Seminars in Oncology, 46, 48-56. https://doi.org/10.1053/j.seminoncol.2018.11.005
Ngo, L., Hee, S.W., Lim, L.C., et al. (2008) Prognostic Factors in Patients with Diffuse Large B Cell Lymphoma: Before and after the Introduction of Rituximab. Leukemia & Lymphoma, 49, 462-469. https://doi.org/10.1080/10428190701809156
(1993) A Predictive Model for Aggressive Non-Hodgkin’s Lymphoma. The New England Journal of Medicine, 329, 987-994. https://doi.org/10.1056/NEJM199309303291402
Li, L., Zhang, X., Zhang, T., et al. (2018) Prognostic Significance of BCL-2 and BCL-6 Expression in MYC-Positive DLBCL. Clinical Lymphoma, Myeloma & Leukemia, 18, e381-e389. https://doi.org/10.1016/j.clml.2018.06.010
Huang, P., Chen, S., Yang, X., et al. (2019) Prognostic Evaluation of P53 and BCL2 Proteins in MYC/BCL2 Double Expression DLBCL. Chinese Journal of Hematology, 40, 589-593.
Sun, R., Zheng, Z., Wang, L., et al. (2021) A Novel Prognostic Model Based on Four Circulating miRNA in Diffuse Large B-Cell Lymphoma: Implications for the Roles of MDSC and Th17 Cells in Lymphoma Progression. Molecular Oncology, 15, 246-261. https://doi.org/10.1002/1878-0261.12834
Taniguchi, K. and Karin, M. (2018) NF-κB, Inflammation, Immunity and Cancer: Coming of Age. Nature Reviews Immunology, 18, 309-324. https://doi.org/10.1038/nri.2017.142
Coussens, L.M. and Werb, Z. (2002) Inflammation and Cancer. Nature, 420, 860-867. https://doi.org/10.1038/nature01322
Jiang, Z., Li, Y., Han, G., et al. (2016) Association of Serum Albumin Level with Clinicopathologic Features and Prognosis in Colon Cancer. Chinese Journal of Gastrointestinal Surgery, 19, 80-83.
Bairey, O., Shacham-Abulafia, A., Shpilberg, O., et al. (2016) Serum Albumin Level at Diagnosis of Diffuse Large B-Cell Lymphoma: An Important Simple Prognostic Factor. Hematological Oncology, 34, 184-192. https://doi.org/10.1002/hon.2233
Kinoshita, A., Onoda, H., Imai, N., et al. (2015) The C-Reactive Protein/Albumin Ratio, a Novel Inflammation-Based Prognostic Score, Predicts Outcomes in Patients with Hepatocellular Carcinoma. Annals of Surgical Oncology, 22, 803-810. https://doi.org/10.1245/s10434-014-4048-0
Wu, M., Guo, J., Guo, L., et al. (2016) The C-Reactive Protein/Albumin Ratio Predicts Overall Survival of Patients with Advanced Pancreatic Cancer. Tumor Biology, 37, 12525-12533. https://doi.org/10.1007/s13277-016-5122-y
Zhou, T., Zhan, J., Hong, S., et al. (2015) Ratio of C-Reactive Protein/Albumin Is an Inflammatory Prognostic Score for Predicting Overall Survival of Patients with Small-Cell Lung Cancer. Scientific Reports, 5, Article No. 10481. https://doi.org/10.1038/srep10481
Cheng, Z., Yan, M., Lu, Y., et al. (2020) Expression of Serum BMP6 and Hepcidin in Cancer-Related Anemia. Hematology, 25, 134-138. https://doi.org/10.1080/16078454.2020.1738098
Karin, M. (2006) Nuclear Factor-kappaB in Cancer Development and Progression. Nature, 441, 431-436. https://doi.org/10.1038/nature04870
Mei, Z., Liu, Y., Liu, C., et al. (2014) Tumour-Infiltrating Inflammation and Prognosis in Colorectal Cancer: Systematic Review and Meta-Analysis. British Journal of Cancer, 110, 1595-1605. https://doi.org/10.1038/bjc.2014.46
Wang, X. and Lin, Y. (2008) Tumor Necrosis Factor and Cancer, Buddies or Foes? Acta Pharmaceutica Sinica, 29, 1275-1288. https://doi.org/10.1111/j.1745-7254.2008.00889.x
Singh, N., Baby, D., Rajguru, J.P., et al. (2019) Inflammation and Cancer. Annals of African Medicine, 18, 121-126. https://doi.org/10.4103/aam.aam_56_18
Liao, C.P., Booker, R.C., Brosseau, J.P., et al. (2018) Contributions of Inflammation and Tumor Microenvironment to Neurofibroma Tumorigenesis. Journal of Clinical Investigation, 128, 2848-2861. https://doi.org/10.1172/JCI99424
Heikkilä, K., Ebrahim, S. and Lawlor, D.A. (2007) A Systematic Review of the Association between Circulating Concentrations of C Reactive Protein and Cancer. Journal of Epidemiology and Community Health, 61, 824-833. https://doi.org/10.1136/jech.2006.051292
Allin, K.H., Bojesen, S.E. and Nordestgaard, B.G. (2009) Baseline C-Reactive Protein Is Associated with Incident Cancer and Survival in Patients with Cancer. Journal of Clinical Oncology, 27, 2217-2224. https://doi.org/10.1200/JCO.2008.19.8440
Chaturvedi, A.K., Caporaso, N.E., Katki, H.A., et al. (2010) C-Reactive Protein and Risk of Lung Cancer. Journal of Clinical Oncology, 28, 2719-2726. https://doi.org/10.1200/JCO.2009.27.0454
Heikkilä, K., Silander, K., Salomaa, V., et al. (2011) C-Reactive Protein-Associated Genetic Variants and Cancer Risk: Findings from FINRISK 1992, FINRISK 1997 and Health 2000 Studies. European Journal of Cancer, 47, 404-412. https://doi.org/10.1016/j.ejca.2010.07.032
Siemes, C., Visser, L.E., Coebergh, J.W., et al. (2006) C-Reactive Protein Levels, Variation in the C-Reactive Protein Gene, and Cancer Risk: The Rotterdam Study. Journal of Clinical Oncology, 24, 5216-5222. https://doi.org/10.1200/JCO.2006.07.1381
Allin, K.H., Nordestgaard, B.G., Zacho, J., et al. (2010) C-Reactive Protein and the Risk of Cancer: A Mendelian Randomization Study. Journal of the National Cancer Institute, 102, 202-206. https://doi.org/10.1093/jnci/djp459
Lin, N., Li, J., Ke, Q., et al. (2020) Clinical Significance of C-Reactive Protein to Albumin Ratio in Patients with Hepatocellular Carcinoma: A Meta-Analysis. Disease Markers, 2020, Article ID: 4867974. https://doi.org/10.1155/2020/4867974
Liu, Z., Jin, K., Guo, M., et al. (2017) Prognostic Value of the CRP/Alb Ratio, a Novel Inflammation-Based Score in Pancreatic Cancer. Annals of Surgical Oncology, 24, 561-568. https://doi.org/10.1245/s10434-016-5579-3
Ni, X.F., Wu, J., Ji, M., et al. (2018) Effect of C-Reactive Protein/Albumin Ratio on Prognosis in Advanced Non-Small-Cell Lung Cancer. Asia-Pacific Journal of Clinical Oncology, 14, 402-409. https://doi.org/10.1111/ajco.13055
Wu, J., Tan, W., Chen, L., et al. (2018) Clinicopathologic and Prognostic Significance of C-Reactive Protein/Albumin Ratio in Patients with Solid Tumors: An Updated Systemic Review and Meta-Analysis. Oncotarget, 9, 13934-13947. https://doi.org/10.18632/oncotarget.24172
Xu, S., Li, X., Liu, Y., et al. (2019) Inflammasome Inhibitors: Promising Therapeutic Approaches against Cancer. Journal of Hematology & Oncology, 12, 64. https://doi.org/10.1186/s13045-019-0755-0