Purpose: We aimed to investigate the value of inflammation-based prognostic scores for predicting early complications after radical surgery for colorectal carcinoma.
Methods: We retrospectively analyzed data of 154 patients who underwent elective resection of colorectal carcinoma between January 2017 and December 2018 at Beijing Friendship Hospital. Univariate, multivariate, and receiver operating characteristic curve analyses were conducted. As inflammation indices, we evaluated the preoperative modified Glasgow Prognostic Score (GPS), as well as the C-reactive protein/albumin ratio (CAR), postoperative GPS, and C-reactive protein levels on postoperative day 3 (POD3).
Results: Within 30 days postoperatively, complications occurred in 80 patients (51.9%). And high levels of preoperative mGPS (P=0.002), preoperative CAR (P=0.019), POD3 CAR (P< 0.001) and POD3 poGPS (P< 0.001) can significantly affect postoperative complications after surgery for colorectal cancer, with CRP on POD3 (odds ratio, 1.015; 95% confidence interval, 1.006– 1.024; P=0.001) as independent risk factors. Among all inflammation-based indicators, POD3 CAR had the highest area under the curve (0.711) and positive predictive value (83.2%). Higher CAR (≥ 2.6) on POD3 was associated with a higher rate of complications (92.9% vs 36.6%, P< 0.001), especially of infectious nature (54.8% vs 16.1%, P< 0.001).
Conclusion: CAR≥ 2.6 on POD3 reflects sustained systemic inflammation and represents a useful predictor of complications after surgery for colorectal carcinoma, facilitating early detection, timely intervention, and enhanced recovery.


Keywords: C-reactive protein, albumin, Glasgow Prognostic Score, colorectal carcinoma, surgery, postoperative complications, risk prediction


INTRODUCTION

Colorectal carcinoma is the third most common malignant tumor worldwide, with surgical resection being the only effective treatment currently available.1,2 Despite important advances in surgical techniques, the overall rate of complications remains high, at around 30%.3 Postoperative complications are associated with increased treatment costs, prolonged hospital stay, delayed adjuvant chemotherapy, increased risk of recurrence, and a detrimental impact on survival.4–7 Therefore, timely and precise detection and treatment of any complication are critical to improving prognosis after colorectal carcinoma surgery.

In recent years, inflammatory response-based prognostic scoring systems have been developed as tools for clinical evaluation to aid in decision-making. The most common predictors include the C-reactive protein/albumin ratio (CAR), modified Glasgow Prognostic Score (mGPS), postoperative Glasgow Prognostic Score (poGPS), and neutrophil-to-lymphocyte ratio. Most studies in patients with colorectal carcinoma focused primarily on the oncologic prognosis and rarely reported on the performance of predictors for postoperative complications. Tissue trauma caused by surgery affects the body’s metabolic, neuroendocrine, and immune response. An immune response is reflected as an increase in the expression of pro-inflammatory cytokines and the subsequent increase in the levels of C-reactive protein (CRP) and albumin in the acute phase protein.8 Warschkow et al conducted a meta-analysis of studies covering 1832 patients and found that increased CRP levels on postoperative days (PODs) 3 and 4 were good predictors of postoperative complications.9 Labgaa et al found that early postoperative reduction in albumin levels was a predictor of postoperative complications.10 Therefore, we hypothesized that indices that combine CRP and albumin information would be useful for patient stratification according to the risk of postoperative complications. In this study, we examined the value of CAR, mGPS, and poGPS as predictors of early postoperative complications in patients who underwent surgery for colorectal carcinoma.

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