Relationship Between C-Reactive Protein-Albumin Ratio and Metastasis in Breast Cancer
Abstract
Background: Breast cancer is a type of malignancy with the highest number of cases in the world and Indonesia. The C-reactive protein-albumin ratio (RCA) is a simple, feasible, and objective breast cancer serum marker representing inflammatory and nutritional status. There are not many studies regarding the relationship between RCA and breast cancer metastasis, especially in the advanced-stage case population in Indonesia.
Method: Study with a cross-sectional design in 180 breast cancer patients stage III and IV at Cipto Mangunkusumo Hospital, who were diagnosed in 2018 until 2023. Comparative analysis of the RCA values between the groups with and without metastasis was carried out using the Chisquare test. All statistical test results are considered significant if the p-value is < 0.05.
Results: A receiver-operating characteristic curve (ROC) is a graphical analytical technique used to assess the effectiveness of a binary diagnostic classification method. The ROC area under the curve (AUC) value was 0.713 (IC 95%; 0.638–0.789) and significance < 0.001, with the RCA cut-off value was 0.515 with sensitivity 74.4% and specificity 67.8%. The high RCA proportion was 53.3%. There is a significant relationship (p-value < 0,001) between RCA level and the risk of metastasis in breast cancer patients. Liver and lung metastases of breast cancer are the most frequent locations.
Conclusion: The CRP-albumin ratio has a significant relationship with the incidence of metastasis in breast cancer
Keywords
DOI: 10.33371/ijoc.v19i1.1224
Article Metrics
Abstract View: 191, 
PDF Download: 112
References
Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–49.
Sharma R. Global, regional, national burden of breast cancer in 185 countries: evidence from GLOBOCAN 2018. Breast Cancer Res Treat. 2021;187(2):557–67.
McDonald ES, Clark AS, Tchou J, et al. Clinical diagnosis and management of breast cancer. J Nucl Med. 2016;57:9S-16S.
Ji L, Cheng L, Zhu X, et al. Risk and prognostic factors of breast cancer with liver metastases. BMC Cancer. 2021;21(1):1–15.
Liu Y, Liu B, He Y, et al. Analysis of risk factors related to breast cancer metastasis: A retrospective nested case-control study. J BUON. 2021;26(4):1415–21.
Cetintas S, Tezcan G, Tunca B, et al. Prediction of breast cancer metastasis risk using circulating tumor markers: A follow-up study. Bosn J Basic Med Sci. 2019;19(2):172–9.
Cianfrocca M, Goldstein LJ. Prognostic and predictive factors in early-stage breast cancer. Oncologist. 2004;9(6):606-16.
Rakha EA, Ellis IO. Modern classification of breast cancer: Should we stick with morphology or convert to molecular profile characteristics. Adv Anat Pathol. 2011;18(4):255–67.
Xiao W, Zheng S, Liu P, et al. Risk factors and survival outcomes in patients with breast cancer and lung metastasis: a population-based study. Cancer Med. 2018;7(3):922–30.
Zhou L, Ma S, Balde AI, et al. A Retrospective Propensity Score Matched Study of the Preoperative C-Reactive Protein to Albumin Ratio and Prognosis in Patients with Resectable Non-Metastatic Breast Cancer. Med Sci Monit. 2019;25:4342-4352.
Xu HJ, Ma Y, Deng F, et al. The prognostic value of C-reactive protein/albumin ratio in human malignancies: An updated meta-analysis. Onco Targets Ther. 2017;10:3059–70.
Cui X, Jia Z, Chen D, et al. The prognostic value of the C-reactive protein to albumin ratio in cancer: An updated meta-analysis. Medicine (United States). 2020;99(14).
Sun P, Chen C, Xia Y, et al. The Ratio of C-Reactive Protein/Albumin is a Novel Inflammatory Predictor of Overall Survival in Cisplatin-Based Treated Patients with Metastatic Nasopharyngeal Carcinoma. Dis Markers. 2017;2017.
Oeffinger KC, Fontham ETH, Etzioni R, et al. Guideline update from the American cancer society. JAMA. 2015;314(15):1599–614.
Weigelt B, Geyer FC, Reis-Filho JS. Histological types of breast cancer: How special are they? Mol Oncol. 2010;4(3):192–208.
Elston CW, Ellis O. Pathological prognostic factors in breast cancer. The value of histological grade in breast cancer: experience from a large study with long‐term follow‐up. Histopathology. 1991;19(5):403–10.
Sugiarto Hadiyanto AV, Miranti IP, Prajoko YW, Istiadi H. Histological and Clinical Stage Profiles of Young-aged Breast Carcinoma. Diponegoro International Medical Journal. 2022;3(1):1–6.
Gujam FJA, McMillan DC, Mohammed ZMA, et al. The relationship between tumour budding, the tumour microenvironment and survival in patients with invasive ductal breast cancer. Br J Cancer. 2015;113(7):1066–74.
Houvenaeghel G, Cohen M, Classe JM, et al. Lymphovascular invasion has a significant prognostic impact in patients with early breast cancer, results from a large, national, multicenter, retrospective cohort study. ESMO Open. 2021;6(6):100316.
Mohammed RAA, Martin SG, Gill MS, et al. Improved methods of detection of lymphovascular invasion demonstrate that it is the predominant method of vascular invasion in breast cancer and has important clinical consequences. American Journal of Surgical Pathology. 2007;31(12):1825–33.
Song YJ, Shin SH, Cho JS, et al. The role of lymphovascular invasion as a prognostic factor in patients with lymph node-positive operable invasive breast cancer. J Breast Cancer. 2011;14(3):198–203.
Sotiriou C, Pusztai L. Gene-Expression Signatures in Breast Cancer. New England Journal of Medicine. 2009;360(8):790–800.
Pandit P, Patil R, Palwe V, et al. Prevalence of Molecular Subtypes of Breast Cancer: A Single Institutional Experience of 2062 Patients. Eur J Breast Health. 2020;16(1):39–43.
Li YJ, Yao K, Lu MX, et al. Prognostic value of the C-reactive protein to albumin ratio: A novel inflammation-based prognostic indicator in osteosarcoma. Onco Targets Ther. 2017;10:5255–61.
Fan Z, Fan K, Gong Y, et al. The CRP/albumin ratio predicts survival and monitors chemotherapeutic effectiveness in patients with advanced pancreatic cancer. Cancer Manag Res. 2019;11:8781–8.
Wu J, Tan W, Chen L, et al. Clinicopathologic and prognostic significance of C-reactive protein/albumin ratio in patients with solid tumors: An updated systemic review and meta-analysis. Oncotarget. 2018;9(17):13934–47.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Email this article 
