The Elevated Pre-Treatment C-Reactive Protein Predicts Poor Prognosis in Patients with Locally Advanced Rectal Cancer Treated with Neo-Adjuvant Radiochemotherapy

Abstract

The aim of the present study was to investigate the association of the pre-treatment C-reactive protein (CRP) plasma level with survival outcomes in a cohort of 423 consecutive patients with locally advanced rectal cancer treated with neo-adjuvant radiochemotherapy followed by surgical resection. To evaluate the prognostic value of the CRP level for clinical endpoints recurrence-free survival (RFS), local-regional control (LC), metastases-free survival (MFS), and overall survival (OS), uni- and multivariate Cox regression analyses were applied, and survival rates were calculated using Kaplan–Meier analysis. The median follow-up time was 73 months. In univariate analyses, the pre-treatment CRP level was a significant predictor of RFS (hazard ratio (HR) 1.015, 95% CI 1.006–1.023; p < 0.001), LC (HR 1.015, 95% CI 1.004–1.027; p = 0.009), MFS (HR 1.014, 95% CI 1.004–1.023; p = 0.004), and OS (HR 1.016, 95% CI 1.007–1.024; p < 0.001). Additionally, univariate analysis identified the MRI circumferential resection margin (mrCRM) and pre-treatment carcinoembryonic antigen (CEA) as significant predictor of RFS (HR 2.082, 95% CI 1.106–3.919; p = 0.023 and HR 1.005, 95% CI 1.002–1.008; p < 0.001). Univariate analysis also revealed a significant association of the mrCRM (HR 2.089, 95% CI 1.052–4.147; p = 0.035) and CEA (HR 1.006, 95% CI 1.003–1.008; p < 0.001) with MFS. Age and CEA were prognostic factors for OS (HR 1.039, 95% CI 1.013–1.066; p = 0.003 and HR 1.005, 95% CI 1.002–1.008; p < 0.001). In multivariate analysis that included parameters with a p-level < 0.20 in univariate analysis, the pre-treatment CRP remained a significant prognostic factor for RFS (HR 1.013, 95%CI 1.001–1.025; p = 0.036), LC (HR 1.014, 95% CI 1.001–1.027; p = 0.031), and MFS (HR 1.013, 95% CI 1.000–1.027; p = 0.046). The results support the hypothesis that an elevated pre-treatment CRP level is a predictor of poor outcome. If confirmed by additional studies, this easily measurable biomarker could contribute to the identification of patients who might be candidates for more aggressive local or systemic treatment approaches or the administration of anti-inflammatory drugs.

C-Reactive Protein (CRP)/Albumin Ratio (CAR) pre-treatment as a predictive factor of radiological response after neoadjuvant chemotherapy in Locally Advanced Rectal Cancer (LARC) patients at Dr. Soetomo General Hospital, Surabaya, Indonesia

“…A study conducted by Partl R et al, in 2020 concluded that the increased pretherapy CRP has a poor outcome in patients. 12 These results are in line with a systematic review and meta-analysis using 3,431 colorectal patients, which revealed a significant relationship between the increased CAR values and poor patient prognosis. 4 This study also concluded that a high CAR value indicates a poorer prognosis in colorectal cancer patients than a low CAR value, indicating that CAR is a valuable prognostic indicator to predict the radiologic response after NAC treatment.…”

C-Reactive Protein as Predictive Biomarker for Response to Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer: A Retrospective Study

“…Similar to our results, an elevated CRP also predicted a bad prognosis. Particularly, in locally advanced rectal cancer patients, Parti et al [55] investigated the association of the pretreatment CRP plasma level with survival outcomes in a cohort of 423 consecutive patients treated with nCRT. In a multivariate analysis, the pretreatment CRP remained a significant prognostic factor for recurrence-free survival (HR = 1.013, 95%CI 1.001-1.025; p = 0.036), loco-regional control (HR = 1.014, 95% CI 1.001-1.027; p = 0.031), and metastasesfree survival (HR = 1.013, 95% CI 1.000-1.027; p = 0.046).…”

Development and Validation of a Risk Prediction Score for Patients with Nasopharyngeal Carcinoma

“…Moreover, there is accumulating evidence indicating that in ammation plays an important role in carcinogenesis and tumor proliferation [22]. There has been reported that in ammation-based markers could be used as a potential prognostic factor for many cancers, such as CRP, neutrophils, lymphocytes, dNLR, ALB [23][24][25]. Neutrophils secreted proangiogenic cytokines, including IL-8, MMP-9, MMP-8, and VEGF, and these cytokines contribute to tumor angiogenesis and progression [26,27].…”