Elevated baseline C-reactive protein levels predict poor progression-free survival in sporadic vestibular schwannoma

Abstract

Background Recent investigations showed emerging evidence of the role of inflammation in the growth of sporadic vestibular schwannoma (VS). The present retrospective study investigated the impact of systemic inflammation on tumor progression using serum C-reactive protein (CRP) levels in a series of 87 surgically treated sporadic VS patients. Methods The optimal cut-off value for CRP was defined as 3.14 mg/dl according to the receiver operating characteristic curve (AUC: 0.70, 95% CI 0.47–0.92). Patient cohort was dichotomized into normal (n = 66; < 3.14 mg/dl) and high baseline (n = 21; ≥ 3.14 mg/dl) CRP groups. Results No significant differences in age, sex, comorbidities influencing the systemic inflammatory state, Karnofsky performance status (KPS), tumor size, extent of resection, or MIB-1 index were identified between the two groups defined by the baseline CRP levels. Univariable analysis demonstrated that a high CRP level (≥ 3.14 mg/dl) is significantly associated with a shortened progression-free survival (PFS) (hazard ratio (HR): 6.05, 95% CI 1.15–31.95, p = 0.03). Multivariable Cox regression analysis considering age, extent of resection, KPS, tumor size, and baseline CRP confirmed that an elevated CRP level (≥ 3.14 mg/dl) is an independent predictor of shortened PFS (HR: 7.20, 95% CI 1.08–48.14, p = 0.04). Conclusions The baseline CRP level thus serves as an independent predictor of PFS. Further investigations of the role of inflammation and tumor inflammatory microenvironment in the prediction of prognosis in sporadic VS are needed. Graphical abstract

Evidence for inflammation in normal-appearing brain regions in patients with growing sporadic vestibular schwannoma: A PET study

“…Recent studies have for example demonstrated elevated neutrophil-to-lymphocyte ratio, a systemic marker of inflammation, in patients with growing VS, 34 and decreased progression-free survival in patients with a high baseline serum CRP (≥3.14 mg/dL) level at the time of VS diagnosis. 35 In keeping with the dense infiltration of tumor-associated macrophages seen in growing VS, studies have also shown upregulation of numerous monocytic cytokines in the plasma of patients with growing VS. 14 Evidence that sporadic VS can have widespread effects remote to the tumor also comes from studies of SNHL in affected patients, with emerging evidence that direct damage to cochlea hair cells may occur through factors secreted into the CSF or blood by the tumor such as MMP-14 and the pro-inflammatory cytokine TNFα. 4 , 5 , 36 There has to date, however, been no assessment of VS induced inflammatory changes within the brain parenchyma itself.…”

Predictive Power of MIB-1 vs. Mitotic Count on Progression-Free Survival in Skull-Base Meningioma

“…Kaplan-Meier estimates were used to visualize the probability of PFS in either MIB-1 and MC groups. To evaluate the time-varying performance of MIB-1 and MC on PFS time-dependent ROC analysis was conducted using the R package "risksetROC" of the R software (version 4.0.4; R Foundation for Statistical Computing, Vienna, Austria) [21,22].…”

C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians

“…A shortened progression-free survival has also been reported for sporadic vestibular schwannoma patients with notably elevated baseline CRP (approx. > 31 mg/L), and hsCRP has been associated with poor cognitive function in acoustic neuroma [ 871 , 872 ]. Additionally, an interesting study found that cases with craniopharyngiomas and Rathke’s cleft cysts had higher CRP than those with pituitary adenomas, revealing their higher systemic inflammation [ 873 ].…”