C-reactive protein level is a prognostic indicator for survival and improves the predictive ability of the R-IPI score in diffuse large B-cell lymphoma patients

Abstract

Background:High levels of C-reactive protein (CRP), an acute phase protein, proofed being associated with decreased clinical outcome in small-scale studies in diffuse large B-cell lymphoma (DLBCL). The aim of this study was to evaluate the prognostic impact of pretreatment CRP levels on overall survival (OS) and disease-free survival (DFS) in a large bicentre study of DLBCL patients.Methods:Data from 477 DLBCL patients, diagnosed and treated between 2004 and 2013 at two Austrian centres, were evaluated retrospectively. The prognostic influence of CRP and other factors, including age, tumour stage, and revised International Prognostic Index (R-IPI) on 5-year OS and 5-year DFS, were studied by Kaplan–Meier curves as well as univariate and multivariate Cox regression models. Influence of CRP on the predictive accuracy of the R-IPI score was determined by the Harrell concordance index.Results:Kaplan–Meier curves revealed elevated CRP as a factor for decreased 5-year OS and DFS in DLBCL patients (P<0.001, log-rank test). An independent significant association between high CRP levels and poor clinical outcome in multivariate analysis for 5-year OS (HR=1.51, CI 95%=1.04–2.20, P=0.031) and for DFS (HR=1.91, CI 95%=1.28–2.85, P=0.002) was found. The estimated concordance index was 0.75 using the original R-IPI score and 0.79 when CRP was added.Conclusions:In the present study, we demonstrated high CRP levels at diagnosis of DLBCL as an independent poor prognostic factor for clinical outcome. Adding CRP to the well-established prognostic models such as the R-IPI score might improve their predictive ability.

Prognostic Value of the Pretreatment Advanced Lung Cancer Inflammation Index (ALI) in Diffuse Large B Cell Lymphoma Patients Treated with R-CHOP Chemotherapy

“…Furthermore, a variety of systemic inflammatory biomarkers has been identified and studied in patients with DLBCL, and might provide useful prognostic information (Table 4). These biomarkers include NLR [30,31], serum LDH [32], serum CRP [33,34], GPS [35,36], serum albumin [37,38], and the peripheral blood absolute lymphocyte and monocyte counts [39]. Troppan et al [30 ]reported that DLBCL patients with an NLR score <4 at diagnosis experienced better OS and disease-free survival than patients with a score of ≥4.…”

Pretreatment C-reactive protein was an independent prognostic factor for patients with diffuse large B-cell lymphoma treated with RCHOP

“…We also used the same cutoff value for pretreatment CRP concentration (10 mg/l) to evaluate the prognostic significance, results showed that pretreatment CRP concentration was significantly associated with worse OS and PFS at univariate analysis (P = 0.007, P = 0.001, respectively), CRP concentrations remained an independent predictor of OS and PFS at multivariate analysis (HR = 0.42, P = 0.047; HR = 0.58, P = 0.043, respectively). Although study of prognostic potential of CRP concentrations in patients with DLBCL for the rituximab era was very few, partly studies have been reported about association between CRP concentration and DLBCL before the rituximab era [15,16] or mixed groups of patients with various lymphoma subtypes [17,18]. Troppan KT et al [16] retrospectively reviewed 477 patients with newly diagnosed DLBCL at 2 Austrian centers.…”

“…Although study of prognostic potential of CRP concentrations in patients with DLBCL for the rituximab era was very few, partly studies have been reported about association between CRP concentration and DLBCL before the rituximab era [15,16] or mixed groups of patients with various lymphoma subtypes [17,18]. Troppan KT et al [16] retrospectively reviewed 477 patients with newly diagnosed DLBCL at 2 Austrian centers. Increased CRP concentrations were defined as N15 mg/l.…”

Serum C-reactive protein and overall survival of patients with osteosarcoma

“…In addition, elevated levels of CRP had been found in patients with cancers [9][10][11][12]15]. Previous studies also showed that elevated levels of CRP were associated with decreased survival and increased risk of mortality in various cancers [16][17][18][19][20][21][22]. However, there are few studies performed to assess the association between CRP levels and prognosis of osteosarcoma patients.…”