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

Abstract

We investigated whether preoperative levels of serum C-reactive protein (CRP) and its correlation with tumour clinicopathological findings adds prognostic information beyond the time of diagnosis in patients with myeloma bone disease (MM) to facilitate the surgical decision-making process. Six hundred and fifty-eight myeloma patients were evaluated retrospectively for surgery. Clinicopathological variables of patients who underwent surgery (n ¼ 71) were compared between patients with preoperative CRP X6 mg l À1 and those with CRP o6 mg l À1 . Univariate and multivariate analyses were performed to identify prognostic factors after surgery. Patients with an increase of CRP prior to surgery showed inferior survival compared to patients with normal levels. Patients with normal CRP levels at diagnosis but elevations prior to surgery do seem to have a similar unfavourable overall survival (OS) than patients with an increase both, at diagnosis and at surgery. Conversely, patients with normal CRP levels prior to surgery still have the best OS, irrespective of their basic values. Multivariate analysis revealed preoperative CRP levels above 6 mg l À1 Lactate dehydrogenase (LDH) above normal, and osteolyses in long weight bearing bones as independent predictors of survival. These findings suggest that in patients with MM serum levels of CRP increase during disease activity and might be significantly correlated with specific disease characteristics including adverse prognostic features such as osteolyses in long weight bearing bones. Thus, preoperative elevated CRP serum levels might be considered as independent predictor of prognosis and could provide additional prognostic information for the risk stratification before surgical treatment in patients with myeloma bone disease.

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

“…[13][14][15][16][20][21][22][23] Little information is available regarding the prognostic role of the SIR in patients undergoing resection of CLM. Elevated CRP was recently demonstrated to independently predict outcome following metastasectomy.…”

“…12 These cytokines stimulate the release of acute phase proteins, most notably C-reactive protein (CRP). 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.…”

Prognostic Significance of Pre-treatment Serum C-Reactive Protein Level in Patients with Adenocarcinoma of the Uterine Cervix

“…Previous reports have discussed inflammation as being a critical part of tumour progression, with various inflammation-induced cytokines playing a role in cervical carcinogenesis, tumour progression and prognosis (24). To date, the prognostic value of serum CRP has been assessed in different human malignancies (25,26). However, literature regarding the prognostic role of serum CRP in cervical cancer is scanty and mainly focused on squamous cell carcinoma, with no separate data existing for the subset of cervical adenocarcinoma (14,16).…”

Surgical therapy of skeletal complications in multiple myeloma

“…The decision for a surgical procedure depended on the clinical status of the patient and survival estimates based on prognostic factors [5]. Therefore, our surgical treatment ranged from biopsy to spinal decompression with stabilisation.…”

“…Surgery has a supportive role in the management of myeloma and is performed with the intention to stabilise an impending or existing pathological fracture in cases of therapy-refractory pain, neurological complications, or spinal instability [5][6][7]. Although patients with bone metastases have been reported to be at an increased risk for skeletal complications, there is limited data on the correlation between bone lesions and survival in patients with multiple myeloma [8].…”