title: Association of C-reactive protein levels and long-term survival after neoadjuvant therapy and esophagectomy for esophageal cancer.
abstract: BACKGROUND
  Preoperative C-reactive protein (CRP) levels have been shown to be prognostic markers of survival in patients undergoing esophagectomy for cancer. No study has evaluated the predictive value for survival of CRP levels after neoadjuvant chemoradiotherapy.
  
  
  METHODS
  Preoperative CRP levels were assessed in patients undergoing neoadjuvant therapy and esophagectomy for cancer. Groups were defined according to normal value cutoffs of the CRP measurements.
  
  
  RESULTS
  Seventy patients had normal CRP, and 20 patients had raised CRP. The groups did not differ in descriptives, comorbidities, white cell counts, pathological data, or morbidity. In-hospital death was higher in the raised CRP group (three versus one patient, p = 0.048). The Kaplan-Meier survival analysis showed a significant survival advantage of patients with normal CRP compared to patients with raised CRP levels (median survival, 65.4 versus 18.7 months; log rank test, p = 0.027). The Cox regression analysis identified three independent prognostic factors for survival: UICC stage (IIB/III versus I/IIA, HR 3.48, p = 0.007), completeness of resection (HR 6.33, p = 0.002), and CRP levels (raised versus normal, HR 5.07, p = 0.001).
  
  
  CONCLUSIONS
  Preoperative CRP levels are an independent prognostic marker for survival after neoadjuvant treatment in patients with esophageal cancer and may be of value in the re-staging process after neoadjuvant treatment.
authors: Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, SA, Australia. uzingg@gmail.com
authors: Urs
authors: U
authors: Zingg
authors: Jens
authors: J
authors: Forberger
authors: Branimir
authors: B
authors: Rajcic
authors: Christopher
authors: C
authors: Langton
authors: Glyn G
authors: GG
authors: Jamieson
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000097:blood* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D016629:Esophagectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D002097:C-Reactive Protein