title: Serum C-reactive protein concentration and the prognosis of ductal adenocarcinoma of the head of pancreas.
abstract: BACKGROUND
  The prognostic role of serum C-reactive protein in pancreatic cancer has received increasing attention; however the confounding effects of biliary obstruction have not been addressed in previous studies. We sought to determine the prognostic importance of serum CRP prior to biliary intervention in the prognosis of pancreatic adenocarcinoma.
  
  
  METHODS
  A retrospective case note review of patients diagnosed with pancreatic cancer between 2001 and 2006. Clinical, radiological and biochemical criteria were correlated with overall survival. Patients were divided into: Group 1 who underwent potentially curative resection, and Group 2 with advanced unresectable disease managed non-surgically.
  
  
  RESULTS
  In total, 199 patients were included (58 resected). The proportion of patients with biliary obstruction was equal in both groups. Serum CRP and serum bilirubin concentration at presentation were significantly higher among patients in Group 2 compared to Group 1 (P values). On multivariate analysis, advancing age (P=0.012) and raised serum CRP concentration were independently associated with overall survival only in Group 2 patients (P=0.027, 95% CI 0.31-0.93). This association was independent of biliary tract obstruction.
  
  
  CONCLUSIONS
  Raised serum C-reactive protein concentration at the time of presentation of advanced pancreatic cancer carries a poor prognosis independent of biliary tract obstruction.
authors.affiliation: St James's University Hospital, Leeds, UK.
authors.forename: J K
authors.initials: JK
authors.lastname: Pine
authors.forename: K G
authors.initials: KG
authors.lastname: Fusai
authors.forename: R
authors.initials: R
authors.lastname: Young
authors.forename: D
authors.initials: D
authors.lastname: Sharma
authors.forename: B R
authors.initials: BR
authors.lastname: Davidson
authors.forename: K V
authors.initials: KV
authors.lastname: Menon
authors.forename: S H
authors.initials: SH
authors.lastname: Rahman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis*; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D002097:C-Reactive Protein