Preoperative C-reactive protein/albumin ratio is a significant predictor of survival in bladder cancer patients after radical cystectomy: a retrospective study

Yadong Guo,1,* Keke Cai,2,* Shiyu Mao,1,* Junfeng Zhang,1 Longsheng Wang,1 Ziwei Zhang,1 Mengnan Liu,3 Wentao Zhang,3 Yuan Wu,3 Yang Yan,1 Xudong Yao1 1Department of Urology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, People’s Republic of China; 2Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China; 3Department of Anhui Medical University, Hefei, People’s Republic of China *These authors contributed equally to this work Purpose: Earlier studies have indicated the prognostic value of the pretreatment C-reactive protein (CRP)/albumin ratio (CAR) in multiple tumor types. The present study attempts to investigate the predictive role of preoperative CAR in patients with bladder cancer after radical cystectomy (RC), and explores its prognostic index value. Patients and methods: A total of 131 patients with bladder cancer after RC between 2009 and 2015 were analyzed in the present study. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method and Cox regression analyses. Prediction accuracy was evaluated through the area under the receiver operating characteristic curve (AUC). Results: The median follow-up time for all patients in the present retrospective study was 39.72 months (15.51–53.26 months). The Kaplan–Meier curve analysis indicated that bladder cancer patients with high preoperative CAR (>0.2) were significantly associated with decreased PFS and OS (all, P<0.001). The multivariate analysis confirmed CAR as a common independent prognostic factor for PFS and OS. Furthermore, the effective combination of CAR and pathological T staging constituted a new index (CART), and was observed to be an independent risk factor for OS (CART score =2, HR=0.264; 95% CI: 0.106–0.660, P=0.004; CART score =3, HR =0.371; 95% CI: 0.208–0.661, P=0.001). However, CART did not show any prognostic significance for PFS. Importantly, the AUC values of CAR for OS and PFS were higher than other conventional clinical indices. Conclusion: The present study demonstrated that CAR can be used as a new prognostic indicator of OS and PFS in patients with bladder cancer after RC. Combining the CAR score with pathological T staging as the CART score appears to be a more effective prognostic indicator of poor OS, but not PFS. Keywords: bladder cancer, radical cystectomy, prognostic model, C-reactive protein/albumin ratio (CAR