The C-reactive Protein to Albumin Ratio (CAR) Is an Independent Prognostic Factor for Recurrence in Patients With Esophageal Cancer After Esophagectomy

The C-reactive protein to albumin ratio (CAR) is a promising prognostic factor in various malignancies. The aim of the present study was to evaluate the relationship between CAR and unresectable esophageal cancer, and to clarify the role of CAR as a prognostic factor in patients with unresectable esophageal cancer. We retrospectively reviewed the medical records and collected data from consecutive patients with recurrent EC who received any treatment (including best supportive care) after recurrence at Yokohama City University from 2005 to 2022. One hundred patients were included in this study. According to the previous studies and the 1- and 3-year overall survival (OS) rates, we set the cutoff value of CAR at 0.03. In the present study, 100 patients were divided into CAR-low (n=36) and CAR-high (n=64) groups. The 1- and 3-year OS rates were 84.4% and 58.6%, respectively, in the CAR-low group, and 34.7% and 11.1% in the CAR-high group. There were significant differences between the two groups (p<0.001). In the multivariate analysis, CAR was selected as an independent prognostic factor (hazard ratio=4.771, 95% confidence interval=2.559-8.894, p<0.001). When comparing the treatment clinical course between the CAR-low and CAR-high groups, there was a significant difference in the rate of first-line treatment introduction [CAR-low vs. CAR-high: 94.4% (34/36) vs. 73.4% (47/64); p=0.010]. CAR may be a promising prognostic factor in patients with recurrent EC.