Gastric Cancer

, Volume 22, Issue 5, pp 1016–1028 | Cite as

The predictive value of the preoperative C-reactive protein–albumin ratio for early recurrence and chemotherapy benefit in patients with gastric cancer after radical gastrectomy: using randomized phase III trial data

  • Bin-bin Xu
  • Jun Lu
  • Zhi-fang Zheng
  • Jian-wei Xie
  • Jia-bin Wang
  • Jian-xian Lin
  • Qi-yue Chen
  • Long-long Cao
  • Mi Lin
  • Ru-hong Tu
  • Ze-ning Huang
  • Ju-li Lin
  • Chao-hui ZhengEmail author
  • Chang-ming HuangEmail author
  • Ping LiEmail author
Original Article



The definition and predictors of early recurrence (ER) for gastric cancer (GC) patients after radical gastrectomy are unclear.


A minimum-p value approach was used to evaluate the optimal cutoff value of recurrence-free survival to determine ER and late recurrence (LR). Receiver operating characteristic curves were generated for inflammatory indices. Potential risk factors for ER were assessed with a Cox regression model. A decision curve analysis was performed to evaluate the clinical utility.


A total of 401 patients recruited in a clinical trial (NCT02327481) from January 2015 to April 2016 were included in this study. The optimal length of recurrence-free survival to distinguish between ER (n = 44) and LR (n = 52) was 12 months. Factors associated with ER included a preoperative C-reactive protein–albumin ratio (CAR) ≥ 0.131, stage III and postoperative adjuvant chemotherapy (PAC) > 3 cycles. The risk model consisting of both the CAR and TNM stage had a higher predictive ability and better clinical utility than TNM stage alone. Further stratification analysis of the stage III patients found that for the patients with a CAR < 0.131, both PAC with 1–3 cycles (p = 0.029) and > 3 cycles (p < 0.001) could reduce the risk of ER. However, for patients with a CAR ≥ 0.131, a benefit was observed only if they received PAC > 3 cycles (54.2% vs 16.0%, p = 0.004), rather than 1–3 cycles (58.3% vs 54.2%, p = 0.824).


A recurrence-free interval of 12 months was found to be the optimal threshold for differentiating between ER and LR. Preoperative CAR was a promising predictor of ER and PAC response. PAC with 1–3 cycles may not exert a protective effect against ER for stage III GC patients with CAR ≥ 0.131.


Gastric cancer Early recurrence Adjuvant chemotherapy C-reactive protein–albumin ratio Post-recurrence survival 



This study was funded by the Scientific and Technological Innovation Joint Capital Projects of Fujian Province (2016Y9031); the National Nature Science Foundation of China (no. 81871899); the Construction Project of Fujian Province Minimally Invasive Medical Center (no. [2017]171); the second batch of Special Support Funds for Fujian Province Innovation and Entrepreneurship Talents (2016B013); the QIHANG Fund of Fujian Medical University (no. 2016QH025); the Fujian Province Medical Innovation Project (2015-CXB-16); the Fujian Provincial Health and Family Planning Commission Joint Project (WKJ2016-2-27); and the Chinese Physicians’ Association Young Physician Respiratory Research Fund.

Author contributions

JL, BX, ZZ, CHZ and CH conceived the study, analyzed the data, and drafted the manuscript. CHZ, CH and PL helped critically revise the manuscript for important intellectual content. PL, JX, JBW, JXL, QYC, LLC, ML, RHT, ZNH and JL helped collect data and design the study.

Compliance with ethical standards

Conflict of interest

All authors declare that there are no conflicts of interest or financial ties to disclose.

Human rights statement

All procedures followed were in accordance with the ethical standards of the Responsible Committee on Human Experimentation (institutional and national) and with the 1964 Declaration of Helsinki and its later versions.

Informed consent

Informed consent or a suitable substitute was obtained from all patients before being included in the study.

Supplementary material

10120_2019_936_MOESM1_ESM.docx (28 kb)
Supplementary material 1 (DOCX 27 KB)
10120_2019_936_MOESM2_ESM.tif (241 kb)
Supplementary Fig. 1 Flow chart depicting the patient selection process (TIF 241 KB)
10120_2019_936_MOESM3_ESM.tif (234 kb)
Supplementary Fig. 2 Comparison of post-recurrence survival curves between the ER and LR groups (TIF 234 KB)
10120_2019_936_MOESM4_ESM.tif (327 kb)
Supplementary Fig. 3 Comparison of the areas under the receiver operating characteristic curves for early recurrence among the inflammatory indices (TIF 326 KB)


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019

Authors and Affiliations

  1. 1.Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
  2. 2.Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
  3. 3.Key Laboratory of Ministry of Education of Gastrointestinal CancerFujian Medical UniversityFuzhouChina

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