Serum creatinine/cystatin C ratio as a prognostic indicator for patients with colorectal cancer

Shunhui Gao; Hailun Xie; Lishuang Wei; Mingxiang Liu; Yanren Liang; Qiwen Wang; Shuangyi Tang; Jialiang Gan

doi:10.3389/fonc.2023.1155520

Serum creatinine/cystatin C ratio as a prognostic indicator for patients with colorectal cancer

Front Oncol. 2023 Jun 20:13:1155520. doi: 10.3389/fonc.2023.1155520. eCollection 2023.

Authors

Shunhui Gao^{1

2}, Hailun Xie^{2

3}, Lishuang Wei⁴, Mingxiang Liu^{2

3}, Yanren Liang^{2

3}, Qiwen Wang^{2

3}, Shuangyi Tang⁵, Jialiang Gan^{2

3}

Affiliations

¹ Department of Gastrointestinal Surgery, The Second People's Hospital of Nanning, Nanning, China.
² Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital, Guangxi Medical University, Nanning, China.
³ Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, China.
⁴ Department of Geriatric Respiratory Disease Ward, The First Affiliated Hospital, Guangxi Medical University, Nanning, China.
⁵ Department of Pharmacy, The First Affiliated Hospital, Guangxi Medical University, Nanning, China.

Abstract

Background: This study aimed to explore the relationship between creatinine/cystatin C ratio and progression-free survival (PFS) and overall survival (OS) in colorectal cancer (CRC) patients undergoing surgical treatment.

Methods: A retrospective analysis was conducted on 975 CRC patients who underwent surgical resection from January 2012 to 2015. Restricted three-sample curve to display the non-linear relationship between PFS/OS and creatinine-cystatin C ratio. Cox regression model and Kaplan-Meier method were used to evaluate the effect of the creatinine-cystatin C ratio on the survival of CRC patients. Prognostic variables with p-value ≤0.05 in multivariate analysis were used to construct prognostic nomograms. The receiver operator characteristic curve was used to compare the efficacy of prognostic nomograms and the traditional pathological stage.

Results: There was a negative linear relationship between creatinine/cystatin C ratio and adverse PFS in CRC patients. Patients with low creatinine/cystatin C ratio had significantly lower PFS/OS than those with high creatinine/cystatin C ratio (PFS, 50.8% vs. 63.9%, p = 0.002; OS, 52.5% vs. 68.9%, p < 0.001). Multivariate analysis showed that low creatinine/cystatin C ratio was an independent risk factor for PFS (HR=1.286, 95%CI = 1.007-1.642, p=0.044) and OS (HR=1.410, 95%CI=1.087-1.829, p=0.010) of CRC patients. The creatinine/cystatin C ratio-based prognostic nomograms have good predictive performance, with a concordance index above 0.7, which can predict the 1-5-year prognosis.

Conclusion: Creatinine/cystatin C ratio may be an effective prognostic marker for predicting PFS and OS in CRC patients, aid in pathological staging, and along with tumour markers help in-depth prognostic stratification in CRC patients.

Keywords: colorectal cancer; creatinine/cystatin C ratio; nutrition; overall survival; progression-free survival.

Grants and funding

This study was supported by the Guangxi College Students’ Innovation and Entrepreneurship Training Program (No.202110598306), Guangxi medical and health appropriate techology development and application project (No. S2021095), and Young Elite Scientists Sponsorship Program by CAST (2022QNRC001).