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C-Reactive Protein (CRP)/Albumin Ratio (CAR) pre-treatment as a predictive factor of radiological response after neoadjuvant chemotherapy in Locally Advanced Rectal Cancer (LARC) patients at Dr. Soetomo General Hospital, Surabaya, Indonesia

  • Fariza Hakim Rio Branko ,
  • Tomy Lesmana ,


Background: Several serum inflammatory markers have been investigated as prognostic biomarkers for rectal cancer patients, including C-Reactive Protein (CRP)/Albumin Ratio (CAR). We aimed to examine the association between the CAR pre-therapy value and radiological response after neoadjuvant chemotherapy

Methods: We recruited locally advanced rectal cancer patients who underwent FOLFOX first-line neoadjuvant chemotherapy (NAC) at Dr. Soetomo General Hospital (Surabaya, Indonesia) from January 2015 to December 2020. Before neoadjuvant chemotherapy treatment, the C-reactive protein (CRP) and albumin were measured. The chemotherapy response was performed by evaluating the CT scan result before and after the NAC was given. We used RESIST criteria to assess the radiological response after NAC treatment. Data were analyzed using SPSS version 23 for Windows.

Results: We included a total of 102 patients, with the female being the predominant gender with LARC (52%.0). The well-differentiated adenocarcinoma was the most common adenocarcinoma type found in this study (59.8%). We found 57 patients with positive responses and 45 patients with negative responses. Patients with well-differentiated status who had adenocarcinoma had a higher chance to have a positive response to NAC. Patients with low CAR values had a 2.13 times higher chance of having a positive chemotherapy response than patients with high CAR values (95% CI = 1.30-3.30).

Conclusion: There was a significant relationship between high CAR values and poor radiological response after neoadjuvant chemotherapy in locally advanced rectal cancer patients. The CAR value may be a potential biomarker to predict the radiologic response after NAC treatment.


  1. Fazeli MS, Keramati MR. Rectal cancer: a review. Med J Islam Repub Iran. 2015;29:171.
  2. Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin. 2014;64(2):104-117.
  3. Gaertner WB, Kwaan MR, Madoff RD, Melton GB. Rectal cancer: An evidence-based update for primary care providers. World J Gastroenterol. 2015;21(25):7659-7671.
  4. Zhou QP, Li XJ. C-Reactive Protein to Albumin Ratio in Colorectal Cancer: A Meta-Analysis of Prognostic Value. Dose Response. 2019;17(4):1559325819889814.
  5. Liao CK, Yu YL, Lin YC, Hsu YJ, Chern YJ, Chiang JM, et al. Prognostic value of the C-reactive protein to albumin ratio in colorectal cancer: an updated systematic review and meta-analysis. World J Surg Oncol. 2021;19(1):139.
  6. Trakarnsanga A, Ithimakin S, Weiser MR. Treatment of locally advanced rectal cancer: controversies and questions. World J Gastroenterol. 2012;18(39):5521-5532.
  7. Zhang Y, Yan L, Wu Y, Xu M, Liu X, Guan G. Worse treatment response to neoadjuvant chemoradiotherapy in young patients with locally advanced rectal cancer. BMC Cancer. 2020;20(1):854.
  8. Jalil O, Claydon L, Arulampalam T. Review of Neoadjuvant Chemotherapy Alone in Locally Advanced Rectal Cancer. J Gastrointest Cancer. 2015;46(3):219-236.
  9. Kasi A, Abbasi S, Handa S, Al-Rajabi R, Saeed A, Baranda J, et al. Total Neoadjuvant Therapy vs Standard Therapy in Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(12):e2030097.
  10. Kratz F. Albumin as a drug carrier: design of prodrugs, drug conjugates and nanoparticles. J Control Release. 2008;132(3):171-183.
  11. Heys SD, Walker LG, Deehan DJ, Eremin OE. Serum albumin: a prognostic indicator in patients with colorectal cancer. J R Coll Surg Edinb. 1998;43(3):163-168.
  12. Partl R, Lukasiak K, Thurner EM, Renner W, Stranzl-Lawatsch H, Langsenlehner T. The Elevated Pre-Treatment C-Reactive Protein Predicts Poor Prognosis in Patients with Locally Advanced Rectal Cancer Treated with Neo-Adjuvant Radiochemotherapy. Diagnostics (Basel). 2020;10(10):780.
  13. Ali F, Keshinro A, Weiser MR. Advances in the treatment of locally advanced rectal cancer. Ann Gastroenterol Surg. 2020;5(1):32-38.
  14. de Wilt JH, Vermaas M, Ferenschild FT, Verhoef C. Management of locally advanced primary and recurrent rectal cancer. Clin Colon Rectal Surg. 2007;20(3):255-263.
  15. Wardhana AA, Lesmana T. Neutrophil Lymphocyte Ratio (NLR) as a predictive factor radiological response of Neoadjuvant Chemotherapy (NAC) in Locally Advanced Rectal Cancer (LARC). Bali Medical Journal. 2021;10(2):717-723.
  16. Komori K, Kanemitsu Y, Ishiguro S, Shimizu Y, Sano T, Ito S, et al. Clinicopathological study of poorly differentiated colorectal adenocarcinomas: comparison between solid-type and non-solid-type adenocarcinomas. Anticancer Res. 2011;31(10):3463-7.
  17. Lai CC, You JF, Yeh CY, Chen JS, Tang R, Wang JY, et al. Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis. 2011;26(4):473-81.
  18. Herawati S, Kandarini Y, Prabawa IPY. The Correlation between Estimated Glomerular Filtration Rate and Parathyroid Hormone Levels in Predialysis-chronic Kidney Disease Adult Patients at Sanglah General Hospital, Bali, Indonesia. Open Access Macedonian Journal of Medical Sciences. 2021;9(B):470-474.
  19. Yamamoto T, Kawada K, Hida K, Matsusue R, Itatani Y, Mizuno R, et al. Combination of lymphocyte count and albumin concentration as a new prognostic biomarker for rectal cancer. Sci Rep. 2021;11(1):5027.
  20. Black S, Kushner I, Samols D. C-reactive Protein. J Biol Chem. 2004;279(47):48487-48490.
  21. Sproston NR, Ashworth JJ. Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol. 2018;9:754.

How to Cite

Branko, F. H. R., & Lesmana, T. (2022). C-Reactive Protein (CRP)/Albumin Ratio (CAR) pre-treatment as a predictive factor of radiological response after neoadjuvant chemotherapy in Locally Advanced Rectal Cancer (LARC) patients at Dr. Soetomo General Hospital, Surabaya, Indonesia. Bali Medical Journal, 11(1), 50–55.




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Fariza Hakim Rio Branko
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Tomy Lesmana
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