Prognostic Impact of Pre-Treatment CRP/Albumin Ratio in Patients with Advanced-Stage Epithelial Ovarian Cancer.

Background: Systemic inflammation has emerged as a key determinant of prognosis in epithelial ovarian cancer (EOC). The pre-treatment C-reactive protein/albumin (CRP/Alb) ratio integrates host inflammatory and nutritional status, but its prognostic role in advanced-stage EOC remains incompletely defined. Methods: We retrospectively analyzed 256 patients with FIGO stage III-IV high-grade serous ovarian cancer treated at a tertiary oncology center between 2010 and 2024. All patients underwent primary or interval cytoreductive surgery followed by standard platinum-based chemotherapy. Pre-treatment CRP and albumin values obtained within 14 days before therapy were used to calculate the CRP/Alb ratio. Patients were stratified according to the predefined median cut-off (2.32). Overall survival (OS) was the primary endpoint, and progression-free survival (PFS) was the secondary endpoint. Cox regression models were applied for univariate and multivariate analyses. Results: Median follow-up was 81.4 months. The median OS for the entire cohort was 58.1 months. Patients with a CRP/Alb ratio <2.32 had significantly longer OS (74.6 vs 45.6 months; p = 0.003) and PFS (24.8 vs 17.1 months; p = 0.026) compared to those with higher ratios. In multivariate analysis, a CRP/Alb ratio ≥2.32 remained an independent predictor of worse OS (HR = 1.88; 95% CI: 1.12-3.18; p = 0.018), along with age ≥65 years (HR = 2.34; p < 0.001) and ECOG performance status 2-3 (HR = 1.60; p = 0.006). Individual CRP or albumin levels did not retain prognostic significance. Conclusion: The pre-treatment CRP/Alb ratio is a simple, accessible, and independent prognostic biomarker in advanced-stage EOC. Its integration into routine risk assessment may enhance individualized prognostication and help identify high-risk patients who could benefit from closer monitoring and tailored supportive care. Prospective multicenter validation is warranted.