Role of the C-reactive protein-albumin ratio in predicting survival after breast cancer: A systematic review and meta-analysis.

Abstract

<h4>Objective</h4>This review aimed to evaluate the association between C-reactive protein-albumin ratio (CAR) and survival outcomes in patients with breast cancer.<h4>Methodology</h4>Databases of PubMed, Embase, Scopus, and Web of Science were searched up to 3^rd November 2025. Included studies involved adult patients with histologically confirmed breast cancer that reported hazard ratios (HRs) and 95% confidence intervals (CIs) for either overall survival (OS) or disease-free survival (DFS).<h4>Results</h4>Six studies involving 2,427 patients were included. The pooled analysis demonstrated that elevated CAR was significantly linked with worse OS (HR = 2.66, 95% CI 1.64-4.31) and poorer DFS (HR = 2.39, 95% CI 1.50-3.82). Subgroup analyses revealed consistent associations across study design, cancer subtype, stage, country, and follow-up duration. Meta-regression showed that CAR cut-off value did not significantly influence the effect size for either OS or DFS. Sensitivity analyses indicated stable results.<h4>Conclusions</h4>An elevated CAR may be associated with poorer OS and DFS in breast cancer. Given the scarce evidence, further research is needed to provide robust results. <b><i>Registration No:</i></b> PROSPERO database (CRD420251181780).