Pretreatment C‐reactive protein/albumin ratio is associated with poor survival in patients with stage <scp>IB</scp>‐<scp>IIA</scp> cervical cancer

<jats:title>Abstract</jats:title><jats:p>Previous studies have shown that the C‐reactive protein/albumin ratio (<jats:styled-content style="fixed-case">CAR</jats:styled-content>) is a prognostic indicator in multiple types of carcinomas. This study is the first to evaluate the prognostic significance of <jats:styled-content style="fixed-case">CAR</jats:styled-content> in stage <jats:styled-content style="fixed-case">IB</jats:styled-content>‐<jats:styled-content style="fixed-case">IIA</jats:styled-content> cervical cancer patients treated with radical surgery, as well as that of several other inflammation‐based factors, including the neutrophil‐to‐lymphocyte ratio (<jats:styled-content style="fixed-case">NLR</jats:styled-content>), platelet‐to‐lymphocyte ratio (<jats:styled-content style="fixed-case">PLR</jats:styled-content>), and prognostic nutritional index (<jats:styled-content style="fixed-case">PNI</jats:styled-content>). A total of 235 patients were enrolled in this study. The optimal cut‐off values of <jats:styled-content style="fixed-case">CAR</jats:styled-content> and other inflammation‐based factors were determined by receiver operating characteristic curves. The Kaplan–Meier method and Cox regression model analysis were performed to determine the independent predictors of progression‐free survival (<jats:styled-content style="fixed-case">PFS</jats:styled-content>) and overall survival (<jats:styled-content style="fixed-case">OS</jats:styled-content>). At a cut‐off value of 0.15, patients with a high <jats:styled-content style="fixed-case">CAR</jats:styled-content> had significantly shorter <jats:styled-content style="fixed-case">PFS</jats:styled-content> and <jats:styled-content style="fixed-case">OS</jats:styled-content> than those with a lower <jats:styled-content style="fixed-case">CAR</jats:styled-content> (<jats:italic>P </jats:italic>< 0.001). A higher <jats:styled-content style="fixed-case">CAR</jats:styled-content> was significantly associated with elevated scores of <jats:styled-content style="fixed-case">NLR</jats:styled-content> and <jats:styled-content style="fixed-case">PLR</jats:styled-content> and a decreased <jats:styled-content style="fixed-case">PNI</jats:styled-content> (<jats:italic>P </jats:italic>< 0.001). Univariate analyses showed that elevated <jats:styled-content style="fixed-case">CAR</jats:styled-content> preoperatively was significantly associated with poor survival; a similar trend was also noted for the <jats:styled-content style="fixed-case">NLR</jats:styled-content>,<jats:styled-content style="fixed-case"> PLR</jats:styled-content>, and <jats:styled-content style="fixed-case">PNI</jats:styled-content>. Multivariate analyses demonstrated that only <jats:styled-content style="fixed-case">CAR</jats:styled-content> was an independent indicator for <jats:styled-content style="fixed-case">PFS</jats:styled-content> (hazard ratio [<jats:styled-content style="fixed-case">HR</jats:styled-content>]: 5.164; 95% confidence interval [<jats:styled-content style="fixed-case">CI</jats:styled-content>]: 2.495–10.687; <jats:italic>P </jats:italic>< 0.001) and <jats:styled-content style="fixed-case">OS</jats:styled-content> (<jats:styled-content style="fixed-case">HR</jats:styled-content>: 4.729; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content>: 2.263–9.882; <jats:italic>P </jats:italic>< 0.001). In conclusion, preoperative <jats:styled-content style="fixed-case">CAR</jats:styled-content> is a novel and superior predictor of poor survival in patients with stage <jats:styled-content style="fixed-case">IB</jats:styled-content>‐<jats:styled-content style="fixed-case">IIA</jats:styled-content> cervical cancer.</jats:p>