The C-reactive protein to albumin ratio predicts postoperative complications in oldest-old patients with colorectal cancer



The C-reactive protein to albumin ratio (CAR) is a simple and useful score for predicting the outcomes of patients with various cancers. The aim of this study was to evaluate the CAR and short-term outcomes in oldest-old patients with colorectal cancer.


A total of 126 patients aged 85 years and older with colorectal cancer who underwent resection for primary colon cancer from April 2015 to December 2018 were included. The preoperative cutoff value of the CAR for predicting postoperative complications was 0.19 on receiver operating characteristic curve analysis. Clinical characteristics and inflammation-based scores were compared between patients with a high CAR (CAR ≥ 0.19, n = 44) and a low CAR (CAR < 0.19, n = 82).


A high preoperative CAR level (≥ 0.19) was significantly associated with stoma construction (p = 0.004), blood loss (p = 0.003), postoperative complications (p = 0.016), and systemic inflammation marker levels, including a low neutrophil to lymphocyte ratio (p = 0.006), a low platelet to lymphocyte ratio (p = 0.005), a low prognostic nutritional index (p < 0.001), and a high modified Glasgow prognostic score (p < 0.001). On univariate and multivariate analyses, only the CAR was an independent predictor of postoperative complications (HR 2.864, p = 0.029).


A high CAR was significantly associated with postoperative complications for oldest-old patients with colorectal cancer.

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Correspondence to Tetsuro Tominaga.

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Hashimoto, S., Tominaga, T., Nonaka, T. et al. The C-reactive protein to albumin ratio predicts postoperative complications in oldest-old patients with colorectal cancer. Int J Colorectal Dis 35, 423–431 (2020).

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  • Inflammation-based score
  • C-reactive protein to albumin ratio
  • Colorectal cancer
  • Oldest-old patient
  • Postoperative complication