title: C-reactive protein level predicts prognosis in patients with muscle-invasive bladder cancer treated with chemoradiotherapy.
abstract: OBJECTIVE
  To investigate the effect of C-reactive protein (CRP) level on the prognosis of patients with muscle-invasive bladder cancer treated with chemoradiotherapy (ChRT), as it is increasingly recognized that the presence of a systemic inflammatory response is associated with poor survival in various malignancies.
  
  
  METHODS
  The clinical records of 88 patients with bladder urothelial carcinoma (cT2-4 N0M0) treated with ChRT were reviewed retrospectively. ChRT comprised external beam radiotherapy to the bladder (40 Gy) with two cycles of cisplatin (50-100 mg) at 3-week intervals. Elevated CRP was defined as > 0.5 mg/dL. The survival rate was calculated using the Kaplan-Meier method, and a multivariate analysis was used to identify significant factors associated with prognosis, using a Cox proportional hazards model.
  
  
  RESULTS
  During the median (range) follow-up of 33 (3-117) months, 19 patients died from bladder cancer; the 5-year cancer-specific survival (CSS) rate was 73%. Ten patients had a high CRP level before ChRT (> or = 0.5 mg/dL) and their CSS rate was significantly worse than that in the remaining patients (P = 0.003). Multivariate analysis showed that CRP and cT stage were independent prognostic indicators for CSS, with a hazard ratio of 1.80 (95% confidence interval 1.01-2.97; P = 0.046). Among 10 patients in those with elevated CRP the CRP levels became normal after ChRT in six, of whom all but one was alive with no evidence of recurrence or metastasis during the follow-up. By contrast, all four with no CRP normalization after ChRT died within 2 years.
  
  
  CONCLUSIONS
  To our knowledge this is the first study to report that elevation of CRP before treatment predicts a poor prognosis in patients with muscle-invasive bladder cancer who are receiving ChRT. Furthermore, failure of CRP levels to normalize after ChRT was associated with extremely poor survival.
authors.affiliation: Department of Urology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Yoshida
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Saito
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Koga
authors.forename: Minato
authors.initials: M
authors.lastname: Yokoyama
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kageyama
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Masuda
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Satoru
authors.initials: S
authors.lastname: Kawakami
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kihara
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism*; D002945:Cisplatin / Q000627:therapeutic use; D015653:Cystectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D002097:C-Reactive Protein; D002945:Cisplatin