Kong FF, Geng X, Liu RM, Zhang WT, Quan B, Zhong Y, Zhu YL. Post-chemotherapy C-reactive protein/albumin ratio predicts prognosis in stage II-III colorectal cancer. World J Gastrointest Surg 2026; 18(2): 112924 [DOI: 10.4240/wjgs.v18.i2.112924]
Corresponding Author of This Article
You-Long Zhu, MD, Department of Gastrointestinal Surgery, Xuzhou Central Hospital, No. 199 Jiefang South Road, Xuzhou 221000, Jiangsu Province, China. b2418273@zju.edu.cn
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Gastroenterology & Hepatology
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Retrospective Study
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Feb 27, 2026 (publication date) through Feb 26, 2026
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World Journal of Gastrointestinal Surgery
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1948-9366
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Kong FF, Geng X, Liu RM, Zhang WT, Quan B, Zhong Y, Zhu YL. Post-chemotherapy C-reactive protein/albumin ratio predicts prognosis in stage II-III colorectal cancer. World J Gastrointest Surg 2026; 18(2): 112924 [DOI: 10.4240/wjgs.v18.i2.112924]
World J Gastrointest Surg. Feb 27, 2026; 18(2): 112924 Published online Feb 27, 2026. doi: 10.4240/wjgs.v18.i2.112924
Post-chemotherapy C-reactive protein/albumin ratio predicts prognosis in stage II-III colorectal cancer
Fei-Fei Kong, Xuan Geng, Ru-Ming Liu, Wen-Tao Zhang, Bin Quan, Yong Zhong, You-Long Zhu
Fei-Fei Kong, Department of Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
Xuan Geng, Ru-Ming Liu, Wen-Tao Zhang, Bin Quan, Yong Zhong, You-Long Zhu, Department of Gastrointestinal Surgery, Xuzhou Central Hospital, Xuzhou 221000, Jiangsu Province, China
Co-corresponding authors: Yong Zhong and You-Long Zhu.
Author contributions: Kong FF designed the research, wrote the first manuscript, conducted the analysis, and provided guidance for the research; Kong FF, Geng X, Liu RM, Zhang WT, Quan B, Zhong Y, and Zhu YL contributed to conceiving the research and analyzing data; Zhong Y and Zhu YL made equal contributions as co-corresponding authors; all authors reviewed and approved the final manuscript.
Supported by The Affiliated Hospital of Xuzhou Medical University, No. 2023ZL08.
Institutional review board statement: The study was approved by the Institutional Review Board of The Affiliated Hospital of Xuzhou Medical University, No. XYFY2025-KL347-01.
Informed consent statement: Data was de-identified and retrospectively collected, and therefore informed consent was not required from each patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Corresponding author: You-Long Zhu, MD, Department of Gastrointestinal Surgery, Xuzhou Central Hospital, No. 199 Jiefang South Road, Xuzhou 221000, Jiangsu Province, China. b2418273@zju.edu.cn
Received: September 16, 2025 Revised: November 4, 2025 Accepted: December 22, 2025 Published online: February 27, 2026 Processing time: 162 Days and 21.8 Hours
Abstract
BACKGROUND
Colorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide. The C-reactive protein/albumin ratio (CAR) has emerged as a potential prognostic marker in various cancers. Nonetheless, if the post-surgical drug therapy CAR is a beneficial predictive component in individuals with CRC remains unclear.
AIM
To investigate the prognostic value of post-adjuvant chemotherapy CAR in comparison with preoperative CAR and other inflammatory markers in patients with stage II-III CRC.
METHODS
This retrospective study included 445 patients with CRC that experienced anti-cancer therapy subsequent to definitive excision. Pre-surgical and post-adjuvant therapeutic regimen CAR, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated to assess the inflammatory state of the patients. First, patients were divided into two groups based on the CAR, NLR, PLR, and SII values. Furthermore, patients were partitioned into four clusters for every parameter based on the long-term variations in measures from before surgery to after chemotherapy: Low, normalized, high, and elevated groups. Multiple studies concerning overall survival (OS) were executed to compensate for well-documented clinicopathological factors. Kaplan-Meier method and Cox regression approaches were applied to evaluate distinct predictive factor.
RESULTS
Post-adjuvant chemotherapy CAR demonstrated the highest area under the curve value (0.8175) among all inflammatory markers for predicting OS. Post-adjuvant chemotherapy inflammatory markers (CAR, NLR, PLR, and SII) showed significantly higher area under the curve values than their preoperative counterparts. Longitudinal analysis revealed that a reduced inflammatory cohort exhibited markedly superior OS than an elevated inflammatory cohort regarding every indicator (all P < 0.0001). The normalized group (high preoperatively but low post-chemotherapy) exhibited notably inferior outlook than the consistently reduced population for CAR (P = 0.0002) and SII (P = 0.0002).
CONCLUSION
These results indicate that post-adjuvant chemotherapy CAR is superior to preoperative measurements and other systemic inflammation-based prognostic scores in predicting outcomes for patients with stage II-III CRC. Longitudinal monitoring of inflammatory markers, particularly CAR, provides valuable prognostic information and may guide clinical decision-making in the post-treatment surveillance period.
Core Tip: In this study, we evaluated inflammation-related prognostic markers in patients with colorectal cancer. The results indicated a strong connection between C-reactive protein/albumin ratio values and adverse prognoses. Moreover, the longitudinal changes of inflammation-related prognostic markers had a significant impact on the prognosis of these patients following adjuvant chemotherapy. Therefore, assessing hematological markers is instrumental in evaluating disease progression and prognosis in patients with colorectal cancer.
