Preoperative C-reactive protein/albumin ratio to predict mortality and recurrence of patients with hepatocellular carcinoma after curative resection

Med Clin (Barc). 2019 Sep 13;153(5):183-190. doi: 10.1016/j.medcli.2018.11.010. Epub 2018 Dec 31.
[Article in English, Spanish]


Background & objectives: Recent studies have shown that the C-reactive protein-to-albumin ratio (CAR) can predict the mortality in patients with hepatocellular carcinoma (HCC). The aim of the present study was to investigate the utility of preoperative CAR for predicting postoperative overall and tumor free survival among HCC patients after radical surgery.

Methods: Preoperative neutrophil-to-lymphocyte ratio (NLR), clinicopathological parameters, laboratory data and patient demographics of 187 patients with HCC receiving initial radical liver resection from Sir Run Run Shaw hospital were evaluated. Multivariate analyses were performed to identify clinical characteristics associated with overall survival (OS) and tumor free survival (TFS). Subsequently, the prognostic value of CAR was evaluated using the area under the curve (AUC) compared with other systemic inflammation-based prognostic scores.

Results: Multivariate analysis revealed that the tumor number [hazard ratio (HR)=2.668; p=0.018] was independently associated with OS. While, the CRP/Alb ratio [HR=0.477; p=0.006] and the tumor number [HR=2.458; p=0.006] were significantly associated with TFS. The AUC values of the CRP/Alb ratio (6 months: 0.868; 12 months: 0.787; 36 months: 0.680) were higher than those of the GPS, mGPS and NLR at all time points in OS.

Conclusion: Preoperative CRP/Alb ratio is an independent prognostic marker with tumor free survival in patients with HCC after curative resection and the prognostic ability was comparable to other applied inflammation-based prognostic scores in both overall and tumor-free survival, especially at the early stage.

Keywords: C-reactive protein/albumin ratio; Carcinoma hepatocelular; Cirugía; Factor pronóstico; Hepatocellular carcinoma; Prognostic factor; Relación proteína C reactiva/albúmina; Surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Area Under Curve
  • Biomarkers
  • C-Reactive Protein / analysis*
  • Carcinoma, Hepatocellular / blood*
  • Carcinoma, Hepatocellular / mortality
  • Carcinoma, Hepatocellular / surgery
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Hepatectomy*
  • Humans
  • Kaplan-Meier Estimate
  • Leukocyte Count
  • Liver Neoplasms / blood*
  • Liver Neoplasms / mortality
  • Liver Neoplasms / surgery
  • Male
  • Middle Aged
  • Neoplasm Proteins / analysis*
  • Neoplasm Recurrence, Local / epidemiology
  • Preoperative Period
  • Prognosis
  • Proportional Hazards Models
  • ROC Curve
  • Retrospective Studies
  • Serum Albumin, Human / analysis*


  • Biomarkers
  • Neoplasm Proteins
  • C-Reactive Protein
  • Serum Albumin, Human