An elevated C-reactive protein concentration, prior to surgery, predicts poor cancer-specific survival in patients undergoing resection for gastro-oesophageal cancer

Abstract

There is increasing evidence that the presence of an ongoing systemic inflammatory response is associated with poor outcome in patients undergoing resection for a variety of tumours. The aim of the present study was to examine the relationship between clinicopathological status, preoperative C-reactive protein concentration and cancer-specific survival in patients undergoing resection for gastro-oesophageal cancer. One hundred and twenty patients attending the upper gastrointestinal surgical unit in the Royal Infirmary, Glasgow, who were selected for potentially curative surgery, were included in the study. Laboratory measurements of haemoglobin, white cell, lymphocyte and platelet counts, albumin and C-reactive protein were carried out at the time of diagnosis. All patients underwent en-bloc resection with lymphadenectomy and survived at least 30 days following surgery. On multivariate analysis, only the positive to total lymph node ratio (hazard ratio (HR) 2.02, 95% confidence interval (CI) 1.44 -2.84, Po0.001) and preoperative C-reactive protein concentration (HR 3.53, 95% CI 1.88 -6.64, Po0.001) were independent predictors of cancer-specific survival. The patient group with no evidence of a preoperative systemic inflammatory response (C-reactive protein p10 mg l À1 ) had a median survival of 79 months compared with 19 months in the elevated systemic inflammatory response group (Po0.001). The results of the present study indicate that in patients selected to undergo potentially curative resection for gastro-oesophageal cancer, the presence of an elevated preoperative C-reactive protein concentration is an independent predictor of poor cancer-specific survival.

C-reactive protein as a predictor of prognosis following curative resection for colorectal liver metastases

“…This is consistent with other studies that found a positive correlation between elevated CRP concentrations, before surgery and a poor outcome in patients who had curative primary tumour resection (Nozoe et al, 2001;McMillan et al, 2003;Canna et al, 2005;Crumley et al, 2006). However, this is the first study to identify such a relationship among patients who have undergone curative resection for CRLM.…”

Evaluation of the prognostic value of systemic inflammation and socioeconomic deprivation in patients with resectable colorectal liver metastases

“…[13][14][15][16][20][21][22][23] Little information is available regarding the prognostic role of the SIR in patients undergoing resection of CLM. Elevated CRP was recently demonstrated to independently predict outcome following metastasectomy.…”

“…2,13,20,23,26,31,39 For simplicity, high numbers of cells indicates cell numbers higher than the cut-off levels and low numbers of cells indicates cell numbers lower than the cut-off levels. Carstairs deprivation scores were analysed following allocation into established UK-based score quintiles.…”

“…12 These cytokines stimulate the release of acute phase proteins, most notably C-reactive protein (CRP). 12 Elevated CRP has been shown to predict shortened long-term survival in a range of solid and haematological malignancies [13][14][15][16] and, in CRC, independently predicted decreased survival following both primary tumour and CLM resection. 2,[17][18][19] Cellular components of the SIR have also been shown to have prognostic significance in malignancy, though published data are scarce compared to that relating to CRP.…”

Significance and Outlook of Preoperative Serum Interleukin-1β and Interleukin-6 as Prognostic Factors in Esophageal Cancer

“…IL-6 and IL-1β are termed "inflammatory cytokines" along with tumor necrosis factor (TNF)-α and are known to act on hepatocytes to promote acute-phase protein (CRP) production [20][21][22]. Previous reports have demonstrated that patients with solid tumors who show high preoperative serum CRP levels have poor prognosis, regardless of the disease stage [23][24][25][26][27][28].…”