2012;17:1C29. the GAR was associated with OS ( 0.83/0.83) (hazard ratio [HR], 1.979; 95% CI, 1.321\2.966; = 0.001) along with carcinoembryonic antigen (CEA; 8.7/8.7, ng/mL; HR, 2.319; 95% CI, 1.569\3.428; 0.001), carbohydrate antigen 19\9 (CA19\9; 18.5/18.5, U/mL; HR, 1.727; 95% CI, 1.178\2.532; = 0.005), and the neutrophil\to\lymphocyte ratio (NLR; 2.9/2.9; HR, 2.132; 95% CI, 1.454\3.126; 0.001), and the area under the ROC (AUROC) curve revealed that the GAR had the largest AUROC among these four clinical characteristics (GAR 0.711 CEA 0.698 CA19\9 0.676 NLR 0.635). A significant difference in OS was observed between patients with low GAR and those with high GAR ( 0.001). Conclusion Globulin\to\albumin ratio is a useful predictor of postoperative survival in patients with CRC. 0.05 selected in the univariate analysis to assess those most closely related to OS. KaplanCMeier analysis and log rank test were used to compare the survival curves for the two groups. Deaths prior to 31 December 2014 were included in this analysis. Statistical analyses were performed using the IBM SPSS statistics version 22.0 software package for Windows (IBM Co., New York, NY, USA) at a significance level of 0.05. 3.?RESULTS A total of 941 patients were enrolled (male:female = 581:360). There were 473 patients with low GAR (GAR 0.83) and 468 with high GAR (GAR 0.83). Table ?Table11 shows the distribution of the categorical clinical background characteristics of the studied patients in the two GAR groups. There were significant differences between the two groups in age (60/ 60, year), tumor site (colon/rectum), number of tumors (1/2), maximum tumor diameter (50/ 50, mm), tumor type (3, 4, 5/0, 1, 2), pathology (well or moderately Flutamide differentiated/others), lymphatic invasion (ly0/ly1, 2, 3), venous invasion (v0/v1, 2, 3), WBC count (6.6/ 6.6, 103/mm3), platelet count (27/ 27, 104/mm3), CEA (8.7/ 8.7, ng/mL), CA19\9 (18.5/ 18.5, U/mL), NLR (2.9/ 2.9), GPS (0/1/2), type of surgery (open/laparoscopic), operative curability (A/B/C), depth of tumor (Tis, T1, T2/T3, T4), and stage (0/I/II/III/IV; 2 test). Table 1 Relationships between the categorical clinical characteristics and GAR in patients Rabbit polyclonal to AGR3 with CRC = 473)= 468)= 473)= 468)= 0.001) along with CEA ( 8.7/8.7, ng/mL; HR, 2.319; 95% CI, 1.569\3.428; 0.001), CA19\9 ( 18.5/18.5, U/mL; HR, 1.727; 95% CI, 1.178\2.532; = 0.005), and NLR ( 2.9/2.9; HR, 2.132; 95% CI, 1.454\3.126; 0.001; Table ?Table44). Table 4 Multivariate analysis in relation to overall survival = 0.505, MannCWhitney 0.001). Patients with high GAR ( 0.83) showed poorer OS than those with low GAR (0.83; Figure Flutamide ?Figure22). Open in a separate window Figure 1 A, Relationship between the globulin\to\albumin ratio (GAR) and overall survival (OS) after surgery for stage 0 colorectal cancer (CRC) patients. B, Relationship between the GAR and OS after surgery for stage I CRC patients. C, Relationship between the GAR and OS after surgery for stage II CRC patients. D, Relationship between the GAR and OS after surgery for stage III CRC patients. E, Relationship between the GAR and OS after surgery for stage IV CRC patients Open in a separate window Figure 2 Relationship between the Flutamide globulin\to\albumin ratio and overall survival after surgery for all stage colorectal cancer (CRC) patients 4.?DISCUSSION Advances in laparoscopic surgery and development of novel chemotherapies are improving the treatment of CRC. In recent years, precision medicine has also played a crucial role in maximizing the effects of therapy and minimizing side effects in individual patients. In addition to general medical information, it is important to explore the individual genetic backgrounds, physiological condition, and disease state of patients using biomarkers, and such information is effective for selection of appropriate treatment for each patient. It has been reported that persistent chronic inflammation is involved in cancer development, progression, and metastasis.25 Therefore, such inflammation is associated with hypermetabolism, weight loss, and anorexia in cancer patients.26 In fact, acute\phase proteins Flutamide such as CRP, which is an important marker of systemic inflammatory response (SIR), is induced by inflammatory cytokines.27 Tumor necrosis factor\ (TNF\), interleukin\10 (IL\10), and IL\6 are also inflammatory cytokines that are well known to be involved in various types of cancer.25 Among them, IL\6 is produced by a variety of cells including T cells, B cells, fibroblasts, monocytes, endothelial cells, and mesangial cells.28 IL\6 is associated with the development and progression of CRC.29 Recent studies have shown that the IL\6 level is significantly increased in the tumor microenvironment and that tumor proliferation is suppressed by anti\IL\6 receptor antibody.30 In fact,.
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