Session Item

Clinical track: Lower GI (colon, rectum, anus)
9306
Poster
Clinical
00:00 - 00:00
C-reactive protein-to-albumin ratio is a predictive marker for anal squamous cell carcinoma
PO-1080

Abstract

C-reactive protein-to-albumin ratio is a predictive marker for anal squamous cell carcinoma
Authors: Martin|, Daniel(1)*[daniel.martin@kgu.de];Rödel|, Franz(1);Balermpas|, Panagiotis(2);Winkelmann|, Ria(3);Rödel|, Claus(1);Fokas|, Emmanouil(1);
(1)University of Frankfurt, Department of Radiotherapy and Oncology, Frankfurt, Germany;(2)University Hospital Zürich, Department of Radiation Oncology, Zürich, Switzerland;(3)University of Frankfurt, Senckenberg Institute for Pathology, Frankfurt, Germany;
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Purpose or Objective

Definitive chemoradiotherapy (CRT) is the primary treatment option for non-metastatic anal squamous cell carcinoma (ASCC). In general, treatment outcomes are good but relapse occurs in up to 40% of all patients. In order to effectively improve outcomes for patients with worse prognosis easily assessable biomarkers are needed to select patients for treatment escalation or de-escalation strategies.

The role of the immune system and inflammation in cancer progression has been elucidated in recent decades and gains more attention as more substances that specifically target pathways of the immune system become available. The prognostic impact of inflammation associated blood cells like leukocytes or neutrophils has been reported in ASCC and other malignancies as well. Recently, the ratio of CRP and albumin (CAR) was studied in several malignancies and a high CAR was associated with worse prognosis in head and neck squamous cell carcinomas, bladder cancer, esophageal cancer and others.

In this study we examined a possible new prognostic marker for patients with ASCC that is easily available.

Material and Methods

We identified 126 patients with ASCC that were treated with standard chemoradiotherapy at our department with available baseline blood parameters. CRP to albumin ratio was calculated by dividing baseline CRP through baseline albumin levels. Associations with clinicopathology parameters were evaluated and the prognostic impact of CAR was tested using univariate cox regression analysis. In order to dichotomize patients in high and low risk groups we used maximally selected rank statistics for disease-free survival (DFS) using the R maxstat package.

Results

After a median follow-up of 34 months, the 3-year locoregional control rate (LRC) and disease-free survival (DFS) was 84% and 78%, respectively. Advanced T-stage and male gender was associated with a higher baseline CAR (p < 0.001, p < 0.01, respectively). Using the log transformed CAR we found a significant association of CAR with distant metastasis free survival (DMFS, HR: 1.31, p= 0.016), DFS (HR: 1.22, p= 0.019) and OS (HR: 1.35, p<0.01) but not LRC. Using the calculated cutoff of 0.117, a high CAR was also associated with worse LRC (p=0.004), DMFS (p=0.01), DFS (p=0.003) and OS (p=0.002). In a multivariate cox regression model, including T-Stage, N-Stage and dichotomized CAR, only N-stage and CAR were significantly associated with worse DFS, whereas only CAR remained significant for LRC. 

Conclusion

Elevated CAR indicates inflammation and poor nutritional status and both these factors can promote tumor progression. Baseline CAR could become a new and cheap biomarker to stratify patients with ASCC to investigate new treatment strategies. Prospective validation of these and other described biomarkers is certainly needed.