Relationship Between Postoperative CRP and Prognosis in Thoracic Esophageal Squamous Cell Carcinoma

Abstract

Background/Aim: Few studies have examined postoperative CRP in esophageal cancer. We investigated the relationship between postoperative CRP values according to the postoperative period and prognosis in esophageal cancer. Patients and Methods: We performed a retrospective cohort study including 187 patients who underwent esophagectomy for esophageal squamous cell carcinoma (ESCC) between January 2008 and October 2016. Results: CRP within 1 month of surgery was not related to overall survival (OS) or recurrence-free survival (RFS). In a univariate analysis, postoperative 2 months (2M)-CRP ≥0.15 ml/dl was associated with poorer OS (41.4 vs. 71.4%, p=0.0002) and RFS (28.9 vs. 51.3%, p=0.007). In a multivariate analysis, 2M-CRP ≥0.15 ml/dl was an independent factor for poorer OS (HR=2.27, 95%CI=1.03-3.34, p=0.005) and RFS (HR=1.65, 95%CI=1.08-2.52, p=0.020). The incidence of postoperative pneumonia was significantly higher in the 2M-CRP ≥0.15 ml/dl group (p=0.026). Conclusion: 2M-CRP ≥0.15 ml/dl is an independent prognostic factor for ESCC. Furthermore, postoperative pneumonia may be associated with patient prognosis after esophagectomy.

Prognostic Significance of Combined Platelet Distribution Width and C-Reactive Protein Score in Esophageal Cancer

“…It is well known that chronic inflammation plays a crucial role in the development and progression of malignant tumors and that CRP is an important indicator of inflammation (17,(33)(34). In the present study, the univariate analyses at the three time points showed that only serum CRP levels at the postoperative time point were positively associated with OS.…”

C-reactive Protein as a Diagnostic and Prognostic Factor of Endometrial Cancer

“…Furthermore, researchers indicated that after multivariate adjustment post-operative high CRP concentration was an independent predictor for worse overall survival with HR = 2.23 (95% CI 1.44-3.47, p<0.001) [29]. A similar study was conducted by Katsurahara et al who examined 187 patients who underwent esophagectomy for esophageal squamous cell carcinoma [30]. Interestingly, CRP levels within the first month after surgery did not correlate with overall survival rate and recurrence-free survival rate.…”

“…Interestingly, CRP levels within the first month after surgery did not correlate with overall survival rate and recurrence-free survival rate. CRP concentrations however, measured 2 months after the surgery show significant correlation with overall survival and recurrence-free survival, HR = 2.27 (95 % C 1.03-3.34, p=0.005) and HR = 1.65 (95 % CI 1.08-2.52, p=0.020) respectively [30]. The cut-off value for CRP concentrations was 1.5 mg/l, and the group with high CRP levels had significantly worse overall survival rate, 41.4 vs. 71.4 %, (p=0.0002) and recurrence-free survival rate RFS, 28.9 vs. 51.3 % (p=0.007) [30].…”

“…CRP concentrations however, measured 2 months after the surgery show significant correlation with overall survival and recurrence-free survival, HR = 2.27 (95 % C 1.03-3.34, p=0.005) and HR = 1.65 (95 % CI 1.08-2.52, p=0.020) respectively [30]. The cut-off value for CRP concentrations was 1.5 mg/l, and the group with high CRP levels had significantly worse overall survival rate, 41.4 vs. 71.4 %, (p=0.0002) and recurrence-free survival rate RFS, 28.9 vs. 51.3 % (p=0.007) [30]. The nonrelevance of the first month measures could be a result of increased CRP production as a response to surgery associated tissue damage of which interfered with the baseline CRP measurement.…”

“…However, considered CRP half-time, which is approximately 19 hours, and previously described researches it could be assumed that this would take place between the first and the second month after the operation. Therefore assessment of CRP level two months after the surgery would be a most likely reliable prognostic indicator [28][29][30][31][32].…”