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

Figures & data

Table 1 Clinicopathological characteristics of patients

Variables	Patients (n)	CRP/Alb ratio <0.210	CRP/Alb ratio ≥0.210	P-value
Total patients	216	95	121	–
Gender				0.230
Male	122	58	64
Female	94	37	57
Age (years)				0.259
<17	98	39	59
≥17	118	56	62
Tumor location				0.082
Extremities	195	82	113
Nonextremities	21	13	8
Enneking stage				0.006
I/II	184	88	96
III	32	7	25
Pathological fracture				0.148
Yes	18	5	13
No	198	90	108
Treatment with NACT				0.236
Yes	179	82	97
No	37	13	24
Body mass index (kg/m^2, mean)	–	20.2	19.3	0.031
NLR				0.003
<2.65	123	65	58
≥2.65	93	30	63
PLR				0.005
<118	75	43	32
≥118	141	52	89
GPS				<0.001
0	128	72	56
1	77	23	54
2	11	0	11

Abbreviations: CRP/Alb ratio, C-reactive protein to albumin ratio; GPS, Glasgow prognostic score; NACT, neoadjuvant chemotherapy; NLR, neutrophil–lymphocyte ratio; PLR, platelet–lymphocyte ratio.

Figure 1 Kaplan–Meier survival curves for overall survival in 216 osteosarcoma patients according to (A) CRP/Alb ratio, (B) NLR, (C) PLR, and (D) the GPS.

Abbreviations: CRP/Alb ratio, C-reactive protein to albumin ratio; GPS, Glasgow prognostic score; NLR, neutrophil to lymphocyte ratio; PLR, platelet to lymphocyte ratio.

Table 2 Univariate and multivariate analyses of overall survival using the Cox proportional hazard model

Variables	Univariate analysis			Multivariate analysis
	HR	95% CI	P-value	HR	95% CI	P-value
Gender (male vs female)	1.18	0.79–1.75	0.401
Age (<17 vs ≥17 years)	1.27	0.86–1.87	0.227
Pathological fracture (yes vs no)	1.29	0.67–2.48	0.463
Tumor site (extremities vs nonextremities)	1.86	1.06–3.27	0.031	1.63	0.92–2.88	0.094
Metastasis	2.74	1.75–4.29	<0.001	1.99	1.23–3.22	0.005
Neoadjuvant chemotherapy (no vs yes)	1.40	0.87–2.24	0.162
PLR (≥118 vs <118)	1.76	1.13–2.75	0.012
NLR (≥2.65 vs <2.65)	1.81	1.23–2.67	0.003
GPS (1/2 vs 0)	1.95	1.33–2.87	0.001
CRP/Alb ratio (≥0.210 vs <0.210)	2.62	1.70–4.03	<0.001	2.21	1.40–3.49	0.001

Abbreviations: CRP/Alb ratio, C-reactive protein to albumin ratio; GPS, Glasgow prognostic score; NLR, neutrophil–lymphocyte ratio; PLR, platelet–lymphocyte ratio.

Figure 2 Comparison of the areas under the ROC curves for prognosis among the inflammation-based prognostic indicators.

Abbreviations: CRP/Alb ratio, C-reactive protein to albumin ratio; GPS, Glasgow prognostic score; NLR, neutrophil to lymphocyte ratio; PLR, platelet to lymphocyte ratio; ROC, receiver operating characteristic.

Table 3 Comparison of the AUCs between inflammation-based prognostic indicators

Variables	AUC	95% CI	P-value	P-value*
CRP/Alb ratio	0.680	0.614–0.742	<0.001	–
NLR	0.644	0.577–0.708	<0.001	<0.001
GPS	0.620	0.552–0.685	0.001	0.003
PLR	0.609	0.540–0.674	0.004	<0.001

Note:

* Comparison of AUC values between the CRP/Alb ratio and other inflammation-based prognostic indicators using Z-test method.

Abbreviations: AUC, area under the curve; CRP/Alb ratio, C-reactive protein to albumin ratio; GPS, Glasgow prognostic score; NLR, neutrophil–lymphocyte ratio; PLR, platelet–lymphocyte ratio.