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 stu...
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2025-05-01
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| author | 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 |
| author_facet | 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 |
| author_sort | Susanna Hilda Hutajulu |
| collection | DOAJ |
| description | 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. |
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| spelling | doaj-art-e7cd5935a7e34a8b9a344333556a58952025-08-20T01:53:42ZengPeerJ Inc.PeerJ2167-83592025-05-0113e1931910.7717/peerj.19319Prognostic significance of C-reactive protein (CRP) and albumin-based biomarker in patients with breast cancer receiving chemotherapySusanna Hilda Hutajulu0Yufi Kartika Astari1Meita Ucche2Nyoman Kertia3Yanri Wijayanti Subronto4Dewi Kartikawati Paramita5Lina Choridah6Ericko Ekaputra7Irianiwati Widodo8Suwardjo Suwardjo9Mardiah Suci Hardianti10Kartika Widayati Taroeno-Hariadi11Ibnu Purwanto12Johan Kurnianda13Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Sleman, Yogyakarta Special Region, IndonesiaDivision of Hematology and Medical Oncology, Department of Internal Medicine, Dr. Sardjito General Hospital, Sleman, Yogyakarta Special Region, IndonesiaStudy Program of Subspecialty, Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Sleman, Yogyakarta Special Region, IndonesiaDivision of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Sleman, Yogyakarta Special Region, IndonesiaDivision of Tropical Medicine and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Sleman, Yogyakarta Special Region, IndonesiaDepartment of Histology and Cell Biology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Sleman, Yogyakarta Special Region, IndonesiaDivision of Radiodiagnosis, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Sleman, Yogyakarta Special Region, IndonesiaDivision of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Sleman, Yogyakarta Special Region, IndonesiaDepartment of Anatomical Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Sleman, Yogyakarta Special Region, IndonesiaDivision of Surgical Oncology, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Sleman, Yogyakarta Special Region, IndonesiaDivision of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Sleman, Yogyakarta Special Region, IndonesiaDivision of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Sleman, Yogyakarta Special Region, IndonesiaDivision of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Sleman, Yogyakarta Special Region, IndonesiaDivision of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Sleman, Yogyakarta Special Region, IndonesiaBackground 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.https://peerj.com/articles/19319.pdfBreast neoplasmsC-reactive proteinAlbuminSurvivalMortality |
| spellingShingle | 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 Prognostic significance of C-reactive protein (CRP) and albumin-based biomarker in patients with breast cancer receiving chemotherapy PeerJ Breast neoplasms C-reactive protein Albumin Survival Mortality |
| title | Prognostic significance of C-reactive protein (CRP) and albumin-based biomarker in patients with breast cancer receiving chemotherapy |
| title_full | Prognostic significance of C-reactive protein (CRP) and albumin-based biomarker in patients with breast cancer receiving chemotherapy |
| title_fullStr | Prognostic significance of C-reactive protein (CRP) and albumin-based biomarker in patients with breast cancer receiving chemotherapy |
| title_full_unstemmed | Prognostic significance of C-reactive protein (CRP) and albumin-based biomarker in patients with breast cancer receiving chemotherapy |
| title_short | Prognostic significance of C-reactive protein (CRP) and albumin-based biomarker in patients with breast cancer receiving chemotherapy |
| title_sort | prognostic significance of c reactive protein crp and albumin based biomarker in patients with breast cancer receiving chemotherapy |
| topic | Breast neoplasms C-reactive protein Albumin Survival Mortality |
| url | https://peerj.com/articles/19319.pdf |
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