Low creatinine-cystatin C ratio correlates with reduced survival in cancer patients in meta-analysis
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Key Takeaway
Consider CCR as a correlated prognostic marker in cancer, but recognize evidence is observational and non-causal.
This meta-analysis examined the prognostic value of the creatinine-cystatin C ratio (CCR) in individuals with cancer. It pooled data from 12 observational trials, encompassing a total of 4439 patients. The primary outcome was overall survival (OS), with progression-free survival (PFS) as a secondary outcome. The comparator for a low CCR was not explicitly reported in the input data.
The main results showed a substantial correlation between a low CCR and reduced OS, with a hazard ratio (HR) of 1.71 (95% CI 1.49-1.96). For PFS, a strong correlation was also observed, with an HR of 1.51 (95% CI 1.29-1.77). Absolute event numbers for these outcomes were not reported. Safety and tolerability data were not available from the provided information.
Key limitations include the observational nature of the included studies, which precludes establishing causality. The specific types of cancer represented in the 4439 individuals were not reported, limiting generalizability. Other standard limitations, such as potential publication bias or heterogeneity, were not detailed in the input. Funding sources and author conflicts of interest were also not reported.
In practice, these findings suggest the CCR may be a promising and affordable prognostic biomarker for cancer patients. However, clinicians should interpret this as a correlation observed in aggregated retrospective data. Its utility for guiding specific clinical decisions in individual patients or cancer subtypes remains uncertain and requires prospective validation.
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View Original Abstract ↓
BACKGROUND: The prognostic value of the creatinine-cystatin C ratio (CCR) in individuals with cancer has been investigated in numerous studies, but the findings vary. To accurately identify the prognostic value of CCR in individuals with cancer, we conducted this meta-analysis.
METHODS: Pertinent studies were retrieved across PubMed, Web of Science, Embase and Cochrane from their establishment to June 8, 2024. Additional searches were conducted until November 16, 2024. In this study, the calculation of the hazard ratio (HR) and its 95% confidence interval (CI) allowed us to determine the prognostic value of CCR in individuals with cancer. Additionally, Newcastle-Ottawa scale (NOS) was employed for quality evaluation, Cochrane I statistic for heterogeneity assessment, funnel plots for publication bias evaluation, and Egger test for quantitative identification. Significant publication bias is indicated by a P < 0.05. A software called STATA 15.1 was utilized for statistical analysis.
RESULTS: Initially, 2001 articles were retrieved in total, and this study comprised twelve trials with 4439 individuals with cancer overall. Our findings demonstrated a substantial correlation between a low CCR and a reduced overall survival (OS) in individuals with cancer (HR 1.71, 95% CI 1.49-1.96). Similarly, a strong correlation between CCR and progression-free survival (PFS) CCR was also noted (HR 1.51, 95% CI 1.29-1.77).
CONCLUSION: This meta-analysis revealed that in individuals with cancer, a low CCR was strongly correlated with OS and PFS. Therefore, in clinical practice, CCR may be a promising and affordable prognostic biomarker for individuals with cancer.
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