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

Abstract

There is increasing evidence that systemic inflammatory response has a positive correlation with a poorer outcome in patients undergoing resection for solid tumours. The aim of this study was to analyse the impact of an elevated C-reactive protein (CRP), an outcome following curative resection for colorectal liver metastases. One hundred and seventy patients who underwent curative resection for colorectal liver metastases were included in the study. Laboratory measurements of haemoglobin, white cell, platelets, albumin and CRP were taken on the day before surgery. Elevated CRP (410 mg l À1 ) was present in 54 (31.8%) patients. The median survival of patients with an elevated CRP was 19 months (95% CI 7.5 -31.2 months) compared to 42.8 months (95% CI 33.2 -52.5 months) for those with a normal CRP, P ¼ 0.004. Similarly, when assessing disease-free survival, patients with an elevated CRP had poorer disease-free survival (median of 11.8 months (95% CI 6.4 -17.3) compared to median of 15.1 months (95% CI 11.1 -19.1)), P ¼ 0.043. The result of the study showed that an elevated preoperative CRP is a predictor of poor outcome in patients undergoing curative resection for colorectal liver metastases.

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

“…Elevated CRP was recently demonstrated to independently predict outcome following metastasectomy. 2,19 Evidence for cellular markers of the SIR in this context has been limited to demonstration of the prognostic significance of the NLR, 2,42 a cellular index devised and validated as a marker of inflammation in patients with cardiovascular disease and critical illness. 24,25 The current study demonstrates that both cellular and acute phase showing no correlation with patient outcome.…”

“…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. Elevated neutrophil, monocyte and/or total leucocyte counts have been reported to predict adverse outcome in patients with a variety of solid tumours, [20][21][22] including primary CRC.…”

Comparison of the prognostic value of selected markers of the systemic inflammatory response in patients with colorectal cancer

“…Similarly, singly these factors have been shown to be tumour stage-independent prognostic factors, prior to surgery, in patients with a variety of primary operable cancers including colorectal cancer (Heys et al, 1998;Longo et al, 1998;Nozoe et al, 1998;Longo et al, 2000;Nielsen et al, 2000;McMillan et al, 2003). Furthermore, Wong et al (2007) showed that an elevated C-reactive protein concentration was an independent predictor of survival in patients undergoing potentially curative surgery for colorectal liver metastases. Recently, the combination of C-reactive protein and albumin, known as the Glasgow Prognostic Score (GPS) has been evaluated pre-operatively in patients undergoing potentially curative surgery for colorectal cancer .…”

Can statins improve outcome in colorectal surgery?: Part I

“…Another relevant aspect refers to recent observations that highlight the relation between the local or systemic inflammation process and the pathogenesis of solid tumors 50,51 in which pro-inflammatory macrophages, cytokines and chemotactic cytokines, acting as factors that predispose the subsequent progression, growth, invasion and metastasis of tumors, would determine the bad prognosis in the treatment of these patients 52 . In this sense, Gunter et al 53 , in 2006, showed the relation of chronic inflammatory process, evidenced through a persistently elevated dose of CRP, with colorectal cancer.…”

“…On the other hand, some genetic epidemiological studies showed that elevated CRP does not cause cancer, but it increased the risk of death caused by cancer 54,55 , suggesting that not only the intrinsic properties of tumors determine their behaviors. Therefore, for these reasons, the prevention of pro-inflammatory activities should be part of the adjuvant therapeutic arsenal in cancer treatment and in prophylaxis of general postoperative complications [50][51][52] . The studies available are still not sufficient to ensure a better evaluation of the pleiotropic effects of statins and their probable benefits in colorectal surgeries, but the University of Auckland, New Zeland 56 , is interested in the topic and has assigned a group to start a multi-center cohort study to help clarify the impact of pleiotropic effects of statins on the prophylaxis of postoperative complications.…”