Serum albumin-creatinine ratio predicts sarcopenia and poor outcomes in patients with colorectal cancer

Background: This study was designed to explore the prognostic significance of the serum albumin-creatinine ratio (ACR) in patients with colorectal cancer (CRC). Methods: Kaplan-Meier survival analysis was utilized to evaluate overall survival (OS) and progression-free survival (PFS). Cox proportional hazards regression models were applied to identify independent prognostic factors. A nomogram based on the ACR was developed to predict 1-, 3-, and 5-year survival probabilities. Results: A total of 1438 patients were included in this study. Patients with a high ACR (≥38.5) had significantly worse outcomes compared with those having a low ACR (<38.5). Specifically, patients with a low ACR had significantly poorer PFS (43.6% vs 63.3%, p<0.001) and OS (46.2% vs 66.2%, p<0.001) than those with a high ACR. The multivariate Cox proportional hazards regression model indicated that ACR was an independent prognostic factor for both PFS (HR = 0.635, 95% CI: 0.532–0.758, p < 0.001) and OS (HR = 0.615, 95% CI: 0.512–0.738, p < 0.001). Logistic regression analysis showed that low ACR was an independent risk factor for disease recurrence (OR = 0.588, 95% CI: 0.439–0.787, p < 0.001) and sarcopenia (OR = 0.674, 95% CI: 0.496–0.917, p < 0.001). The ACR-based nomogram demonstrated good predictive accuracy, with a concordance index of 0.731 for OS and 0.723 for PFS. Conclusions: The serum ACR is a promising prognostic biomarker for predicting poor outcomes in CRC patients.The ACR-based nomogram can serve as a valuable tool for individualized prognosis assessment and treatment planning in clinical practice.