Prognostic value of C-reactive protein to albumin ratio in metastatic colorectal cancer: A systematic review and meta-analysis

BACKGROUND: In recent years, several observational studies have investigated the association between C-reactive protein to albumin ratio (CAR) and prognosis of metastatic colorectal cancer (mCRC), and yielded controversial outcomes. METHODS: Eligible studies assessing the relationship of CAR with survival and clinicopathological parameters in mCRC were searched from PubMed, Cochrane library, and Embase databases up to February 3, 2021. Overall survival (OS), progression-free survival, recurrence-free survival, and disease-free survival were synthetically calculated and compared. RESULTS: A total of 6 studies including 771 patients were enrolled in this systematic review. Pooled results indicated that elevated CAR was significantly associated with poorer OS (hazard ratio: 2.393; 95% confidence interval: 1.949–2.938, P < .01) as well as decreased progression-free survival/disease-free survival/recurrence-free survival (hazard ratio: 1.731; 95% confidence interval: 1.261–2.375, P < .01). Additionally, high CAR was significantly consistent with increased modified Glasgow Prognostic Score and neutrophil–lymphocyte ratio. CONCLUSION: High CAR could be a negative prognostic marker for mCRC patients. More large-sample clinical trials are still needed to confirm the prognostic significance of CAR in mCRC.