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Pretreatment Creatinine to Cystatin C Ratio Predicts Survival in Gastrointestinal CancersLower Creatinine to Cystatin C Ratio Linked to Shorter Survival

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Key Takeaway
Lower pretreatment creatinine-to-cystatin C ratios are significantly associated with poorer overall survival in gastrointestinal cancers.

This meta-analysis evaluated the prognostic value of the pretreatment creatinine-to-cystatin C ratio (CCR) in patients with histologically proven digestive tract cancers. By analyzing data from nine independent cohorts, researchers aimed to determine if CCR could serve as a reliable indicator for overall survival across various gastrointestinal malignancies.

The findings revealed that a lower CCR was significantly associated with shorter overall survival across the entire cohort (HR 1.71). This trend remained consistent across specific cancer types, including esophageal cancer and biliary tract cancer, where lower ratios were linked to a higher hazard of death.

Detailed analysis of reconstructed individual patient data further supported these findings, showing a significant association between low CCR and decreased survival. While the study suggests that CCR may serve as a useful prognostic marker for clinical decision-making, researchers noted that results are based on reconstructed data from Kaplan-Meier curves.

How this fits prior evidence

This meta-analysis addresses a gap in identifying specific biochemical markers for prognosis in gastrointestinal malignancies. While prior coverage has identified surgical interventions that improve survival in esophageal cancer, such as conversion surgery improving 5-year survival to 26.5% versus 11.6%, this finding provides a potential prognostic tool using the creatinine-to-cystatin C ratio to identify high-risk patients before intervention.

Researchers analyzed data from 3,073 adults with confirmed digestive tract cancers, including esophageal and biliary tract cancers. They looked at a specific measurement called the pretreatment creatinine-to-cystatin C ratio (CCR) to see if it could help predict patient outcomes.

The study found that patients with a lower CCR were associated with shorter overall survival. This link was observed across all groups studied, including those with esophageal cancer and biliary tract cancer. Specifically, the data showed a stronger association between lower CCR and shorter survival in cases of biliary tract cancer compared to other types.

Because this was an analysis of existing data rather than a new clinical trial, these results show a link but do not prove that one factor causes another. Additionally, the researchers had to reconstruct some individual patient data from available charts. More prospective studies are needed to confirm if this measurement can be used reliably in everyday medical practice.

What this means for you:
A lower creatinine-to-cystatin C ratio is linked to shorter survival in certain digestive tract cancers.

Common questions

What does the creatinine-to-cystatin C ratio mean for cancer patients?

The study suggests that this specific ratio (CCR) may serve as a prognostic marker. Patients with a lower CCR were associated with shorter overall survival in cases of esophageal, biliary tract, and other gastrointestinal cancers. However, this is an association found in data analysis and does not establish a direct cause.

Which specific types of cancer were included in the study?

The study included 3,073 patients with histologically proven digestive tract cancers. This specifically included esophageal cancer and biliary tract cancer. The findings showed that a lower CCR was associated with shorter survival across all these categories.

Can this test be used to predict treatment success right now?

The study indicates that the ratio may serve as a prognostic marker, but it is not currently a confirmed diagnostic tool. Because the data was reconstructed from existing records and not a new trial, more prospective studies are needed before it can change standard medical practice.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
BackgroundSarcopenia, characterized by loss of skeletal muscle, is associated with unfavorable clinical outcomes in patients with cancer. The creatinine-to-cystatin C ratio (CCR) has emerged as a readily available marker related to muscle reserve. This meta-analysis aimed to examine the prognostic utility of baseline CCR levels in patients with digestive tract cancers.MethodsWe searched PubMed, Embase, Web of Science, and the Cochrane Library from database inception through 22 October 2025. Original cohort studies that enrolled adults with histologically proven digestive tract cancers, reported pretreatment CCR with overall survival hazard ratios, and classified patients using a specific CCR cut-off were included. Risk of bias was evaluated with the Newcastle-Ottawa Scale and the Quality in Prognostic Studies tool. Pooled hazard ratios for overall survival were synthesized. Patient-level survival data were reconstructed from published Kaplan-Meier curves. No original patient-level datasets were obtained from study investigators. Trial sequential analysis (TSA) was performed as an exploratory robustness assessment.ResultsNine independent cohorts comprising 3,073 patients were included. Lower CCR was significantly associated with shorter OS (HR = 1.71; 95% CI: 1.45–2.02; p < 0.001). Stratified analyses showed consistent prognostic associations in esophageal cancer (HR = 2.21; 95% CI: 1.35–3.61; p = 0.002), biliary tract cancer (HR = 2.62; 95% CI: 1.31–5.23; p = 0.006), and gastrointestinal cancers (HR = 1.65; 95% CI: 1.34–2.05; p < 0.001). Reconstructed IPD analysis also showed shorter OS in the low-CCR group (HR = 1.48; 95% CI: 1.32–1.67; p < 0.001). Exploratory trial sequential analysis was consistent with the pooled OS association under prespecified assumptions.ConclusionPretreatment CCR was associated with overall survival in patients with digestive tract cancers. However, further prospective studies are needed to confirm these findings.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420261290556.
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