Clinical implications of serum C‐reactive protein levels in malignant fibrous histiocytoma

Abstract

Paraneoplastic syndromes (PNSs) associated with mesenchymal tumors are uncommon. Previous reports sporadically described inflammatory PNSs with elevated serum Creactive protein (CRP) levels and leukocytosis in patients with inflammatory malignant fibrous histiocytoma (MFH) of soft tissue; however, the relationship between other subtypes of MFH and PNS has not been extensively investigated. Forty-six patients with primary MFH of soft tissues who underwent radical surgery were retrospectively analyzed. These patients were divided into 2 groups according to preoperative serum CRP level: normal (<1.0 mg/dl) and elevated (>1.0 mg/dl). The correlation between serum CRP level and several clinicopathologic factors was analyzed. Correlation between preoperative serum CRP level and metastasis-free and overall survival was also investigated by univariate and multivariate analyses. Elevated preoperative serum CRP levels were found in 65% of patients with a mean of 3.7 mg/dl. There were statistically significant relationships regarding tumor size, depth, histologic subtypes, grade, stage and metastatic rate among normal and elevated CRP groups (p < 0.001, p < 0.02, p < 0.005, p < 0.001, p < 0.001 and p < 0.05, respectively). When the tumor was removed, the elevated CRP level subsided into the normal range and other abnormal laboratory findings diminished in all cases. In 11/14 relapsed cases that showed elevated CRP preoperatively, the serum CRP level re-elevated with tumor relapse. The normal CRP group showed significantly more favorable prognosis than the elevated CRP group in metastasis-free and overall survival on univariate analysis (p < 0.02, p < 0.05, respectively). Patients with MFH frequently present with an inflammatory PNS, such as elevated serum CRP level, which can be a useful marker of disease activity and a valuable prognostic indicator. © 2002 Wiley-Liss, Inc. Key words: malignant fibrous histiocytoma; paraneoplastic syndrome; C-reactive protein; tumor marker; prognosisMalignant fibrous histiocytoma (MFH) is one of the most common soft tissue sarcomas in late adult life. 1 MFH manifests variable histologic subtypes, including pleomorphic-storiform, myxoid, giant cell and inflammatory types. 2 Inflammatory MFHs have been sporadically reported to demonstrate systemic inflammatory symptoms, including fever, leukocytosis with neutrophilia or eosinophilia, accelerated erythrocyte sedimentation rate and elevated serum C-reactive protein (CRP) levels. 3,4 These paraneoplastic syndromes (PNSs) disappear after surgical resection and recur when the tumor relapses. However, such unusual manifestations have rarely been documented in other histologic subtypes of MFH. 5 In our study, the frequency of PNS in MFH was determined and serum CRP levels were evaluated continually as a representative marker of PNS. These data were then correlated with several clinicopathologic factors and prognosis.

Interleukin-6/Soluble Interleukin-6 Receptor Signaling Attenuates Proliferation and Invasion, and Induces Morphological Changes of a Newly Established Pleomorphic Malignant Fibrous Histiocytoma Cell Line

“…37 In our recent study, CRP, which directly reflects IL-6, proved to be significantly associated with the malignancy grade, tumor size, and histological subtypes of MFH. 6 These findings indicate that IL-6 may be responsible for its biological behavior; tumor progression, proliferation, and morphology. It is noteworthy that IL-6 may be elevated as a metabolic abnormality in advanced malignant neoplasms.…”

“…Recently, we reported that the patients with pleomorphic MFH occasionally present inflammatory PNSs such as fever elevation, leukocytosis, and elevated serum C-reactive protein (CRP). 6 Elevated serum CRP level, which appears to directly reflect interleukin (IL)-6 level, proved to be the most representative clinical manifestation. Therefore we speculate that IL-6 may be a critical tumor-associated factor in MFH pathogenesis and progression.…”

Preoperative elevation of serum C – reactive protein is predictive for prognosis in myeloma bone disease after surgery

“…Alterations of serum CRP is a common feature in patients with malignancies which has been found to be adversely prognostic, with patients having elevated CRP levels (Nozoe et al, 1998;Nakanishi et al, 2002;Shimada et al, 2003;Hashimoto et al, 2005). Growing evidence suggests prognostic importance because increased CRP levels are associated with the production of cytokines from tumour cells (Kurzrock, 1997;Legouffe et al, 1998, Yamamura et al, 1998.…”

“…In addition to the prognostic value of baseline biological markers including high levels of b2-microglobulin (B2-M), lactate dehydrogenase (LDH), and serum albumin (Bataille et al, 1992), elevations of serum C-reactive protein (CRP) have been consistently associated with a poor prognosis in myeloma (Tienhaara et al, 1994;Kaneko et al, 2002;Terpos et al, 2003). Several studies regarding the role of preoperative CRP as a predictive indicator for the malignant potential and prognosis in various other cancers have been published (Nozoe et al, 1998;Nakanishi et al, 2002;Shimada et al, 2003;Hashimoto et al, 2005). However, the prognostic significance based on preoperative CRP has not been clarified for myeloma patients, yet.…”

Serum C-Reactive Protein on the Prognosis of Oncology Patients with Acute Renal Failure: An Observational Cohort Study

“…This may suggest that inflammation plays a role in the outcome of oncology patients with ARF. On the other hand, serum CRP level was correlated with poor prognosis in oncology patients per se in other studies (12,14,16,17,28,29), although its mechanism is not well understood yet. In addition, CRP is known to increase with declining kidney function (19,(30)(31)(32).…”