Elevated CRP levels predict poor outcome and tumor recurrence in patients with thymic epithelial tumors: A pro- and retrospective analysis

Janik, Stefan; Bekos, Christine; Hacker, P.; Raunegger, Thomas; Ghanim, Bahil; Einwallner, Elisa; Beer, Lucian; Klepetko, Walter; Müllauer, Leonhard; Ankersmit, Hendrik Jan; Moser, Bernhard

doi:10.18632/oncotarget.17478

Cited by 24 publications

(23 citation statements)

References 48 publications

(62 reference statements)

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“…Overall, we speculate that the observed increases of Fibrinogen, NLR, and PLR result from cancer-related inflammation, which is in line with our previous findings regarding cancer-related inflammation in TETs [ 7 , 12 , 13 ]. To our knowledge, serum biomarkers are not widely used in patients with TETs.…”

Section: Discussionsupporting

confidence: 92%

“…For advanced TETs, the mainstay of treatment is surgical tumor resection combined with multimodal therapy, which results in excellent 5- and 10-year overall survival (OS) rates of 96.5% and 90.9%, respectively [ 7 , 8 ]. However, up to 30% of cases exhibit tumor recurrence, potentially even decades after initial therapy, necessitating lifelong follow-up mandatory [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…We recently demonstrated that increased serum concentrations of C-reactive protein (CRP), heat shock proteins (HSPs), and high-mobility group box-1 (HMGB1) were associated with advanced tumor stage and worse outcome [ 7 , 12 , 13 ]. CRP monitoring is inexpensive, and CRP is currently assessed as a routinely measured marker for TET detection [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic and diagnostic impact of fibrinogen, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio on thymic epithelial tumors outcome

et al. 2018

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BackgroundPeripheral blood-derived inflammation-based markers, such as Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Fibrinogen have been identified as prognostic markers in various solid malignancies. Here we aimed to investigate the prognostic and diagnostic impact of NLR, PLR, and Fibrinogen in patients with thymic epithelial tumors (TETs).ResultsPretreatment Fibrinogen serum concentrations, NLRs and PLRs were highest in patients with TCs and advanced tumor stages. High pretreatment Fibrinogen serum concentration (≥452.5 mg/dL) was significantly associated with worse cause specific survival (CSS; p = 0.001) and freedom from recurrence (FFR; p = 0.043), high NLR (≥4.0) with worse FFR (p = 0.008), and high PLR (≥136.5) with worse CSS (p = 0.032). Longitudinal analysis revealed that compared to patients without tumor recurrence, patients with tumor recurrence had significantly higher NLR (11.8 ± 4.0 vs. 4.70 ± 0.5; p = 0.001) and PLR (410.8 ± 149.1 vs. 228.3 ± 23.7; p = 0.031).ConclusionOverall, Fibrinogen serum concentrations, NLRs, and PLRs were associated with higher tumor stage, more aggressive tumor behavior, recurrence, and worse outcome. Prospective multicenter studies of the diagnostic and prognostic potential of Fibrinogen, NLR, and PLR are warranted.MethodsThis retrospective analysis included 122 patients with TETs who underwent surgical resection between 1999-2015. Fibrinogen serum concentrations, NLRs, and PLRs were measured in patients preoperatively, postoperatively, and later during follow-up. These markers were analyzed for association with several clinical variables, including tumor stage, tumor subtype, FFR, and CSS and to evaluate their prognostic and diagnostic impact for detecting tumor recurrence.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prognostic and diagnostic impact of fibrinogen, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio on thymic epithelial tumors outcome

et al. 2018

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“…Beyond the radiological assessment [ 25 , 26 ], a number of markers, such as C-reactive protein, have been suggested as possible tools to improve the accuracy of follow-up [ 27 ]. If our results will be confirmed by larger studies, preoperative NLR could be used to identify patients with early stage thymoma at higher risk of relapse.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the prognostic role of neutrophil-to-lymphocyte ratio following complete resection of thymoma

Muriana

Carretta

Ciriaco

et al. 2018

J Cardiothorac Surg

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BackgroundThe introduction of the new TNM staging system for thymic epithelial malignancies produced a significant increase in the proportion of patients with stage I disease. The identification of new prognostic factors could help to select patients for adjuvant therapies based on their risk of recurrence. Neutrophil-to-lymphocyte ratio (NLR) has recently gained popularity as reliable prognostic biomarker in many different solid tumors. The aim of this study is to assess the utility of NLR evaluation as a prognostic marker in patients with surgically-treated thymoma.MethodsA retrospective analysis was conducted among patients who underwent resection for thymoma in a single center. Patients were divided in two groups, under (low-NLR-Group = 47 patients, 60%) and above (high-NLR-Group = 32 patients, 40%) a ROC-derived NLR cut-off (2.27). Associations with clinical-pathological variables were analyzed; disease-free survival (DFS) was identified as the primary endpoint.ResultsBetween 2007 and 2017, 79 patients had surgery for thymoma. Overall 5-year DFS was 80%. Univariate survival analysis demonstrated that NLR was significantly related to DFS when patients were stratified for TNM stage (p = 0.043). Five-year DFS in the low-NLR-Group and in the high-NLR-Group were respectively 100 and 84% in stage I-II, and 66 and 0% in stage III. TNM stage resulted as the only independent prognostic factor at multivariate analysis, with hazard ratio of 3.986 (95% CI 1.644–9.665, p = 0.002).ConclusionsHigh preoperative NLR seems to be associated to a shorter DFS in patients submitted to surgery for thymoma and stratified for TNM stage.

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“…Patients with acute infections based on medical reports were excluded from analysis. 22 See Table 1 for patient demographics.…”

Section: Study Populationmentioning

confidence: 99%

Heat shock protein 90α in thymic epithelial tumors and non-thymomatous myasthenia gravis

et al. 2020

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Background: Thymic epithelial tumors (TETs) are rare malignancies with unique association to the autoimmune disease myasthenia gravis (MG). Heat shock proteins (HSPs) harbor great potential as cancer biomarkers and HSP inhibitors approach clinical cancer therapy. Methods: To explore HSP pathophysiology, we assessed sera (immunoassays) and tissues (immunohistochemistry) of TETs (and thymic tissues) for HSP27, phosphorylated (p)HSP27, HSP70 and HSP90α expression in 114 TETs and 26 non-thymomatous MG patients undergoing extended thymectomy. Results: Serum concentrations of HSP90α were significantly increased in patients with thymic carcinomas, thymomas, thymic neuroendocrine tumors and non-thymomatous MG compared to patients who underwent thymectomy revealing regular thymic morphology or controls. In thymoma patients, high serum HSP90α represented a significantly worse prognostic factor for free-from-recurrence, and complete tumor resection led to decreased levels. The expression of HSP90 in nuclei and cytoplasm of tumor cells and non-neoplastic lymphocytes varied with WHO histological subtype. HSP90 was expressed in centroblasts of thymic germinal centers in MG patients. Higher pHSP27 serum concentrations were observed in seropositive MG and those not treated with steroids. Conclusions: HSP data suggest high potential for HSPs as TET cancer biomarkers or as candidates for targeted therapy. Caution is warranted in TET patients with associated MG overexpressing HSPs.

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Elevated CRP levels predict poor outcome and tumor recurrence in patients with thymic epithelial tumors: A pro- and retrospective analysis

Cited by 24 publications

References 48 publications

Prognostic and diagnostic impact of fibrinogen, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio on thymic epithelial tumors outcome

Prognostic and diagnostic impact of fibrinogen, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio on thymic epithelial tumors outcome

Assessment of the prognostic role of neutrophil-to-lymphocyte ratio following complete resection of thymoma

Heat shock protein 90α in thymic epithelial tumors and non-thymomatous myasthenia gravis

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