Abstract
BACKGROUND AND AIMS: Systemic inflammation is closely linked to the development and progression of various cancers, as well as poorer patient outcomes. The role of the c-reactive protein to albumin ratio (CAR) as a predictor of poor prognosis in renal cell carcinoma (RCC) remains insufficiently recognized. METHODS: A literature search was conducted in major English-language databases, including PubMed, EMBASE, and the Cochrane Library, with the search updated to 25 June 2025. Both the odds ratio (OR) and diagnostic odds ratio (DOR) were employed to evaluate the prognostic performance of CAR. RESULTS: This meta-analysis ultimately included 10 studies with a total of 2478 patients with RCC. The results showed that high baseline CAR was significantly associated with poor prognosis or recurrence of RCC. The sensitivity of 0.73 (95% confidence interval [CI]. 0.69-0.77); specificity of 0.69 (95% CI: 0.64-0.74) and DOR of 6.0 (95% CI: 5.0-8.0) were pooled estimated from patient-based analyses. Subsequently, the combined positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were calculated with the results of 2.4 (95% CI: 2.0-2.8) and 0.39 (95% CI: 0.33-0.46), respectively. Furthermore, the area under the curve (AUC) of the summary receiver operating characteristic (SROC), which reflects prognostic accuracy, was 0.77 (95% CI: 0.73-0.81). In addition, subgroup analysis indicated that elevated CAR was more predictive of overall survival (OS) in RCC patients in China. CONCLUSIONS: Our findings indicate that an elevated CAR serves as a strong predictor of poor prognosis or recurrence in patients with RCC.