Elevated preoperative C-reactive protein predicts poor cancer specific survival in patients undergoing resection for non-small cell lung cancer.
BACKGROUND
Although only the minority of patients with non-small cell lung cancer (NSCLC) are suitable for surgical resection, it offers the best possibility of cure. The aim of this study was to examine the relationship between the clinicopathological status, the preoperative systemic inflammatory response, and survival in patients undergoing potentially curative resection for NSCLC.


METHODS
Data from 96 patients who underwent resection of NSCLC between 2000 and 2003 were collected retrospectively and that for 2004-2006 prospectively.


RESULTS
All patients had Eastern cooperative oncology group performance status 0 or 1. No patient had T4, unresectable nodal or metastatic disease, and all macroscopic tumors were removed, with subsequent negative surgical margins. The majority of patients were older than 60 years (71%), men (57%), underwent a lobectomy (65%), and had tumor, node, metastasis stage I disease (66%). Of the markers of the systemic inflammatory response, white cell count, C-reactive protein, and albumin, only an elevated C-reactive protein (>10 mg/L) was associated with cancer-specific survival. On multivariate analysis, only tumor, node, metastasis stage (hazard ratio 1.88, 95% confidence interval 1.34-2.63, p < 0.001) and preoperative C-reactive protein (hazard ratio 1.67, 95% confidence interval 1.01-2.83, p < 0.05) retained independent significance. Those patients with a preoperative C-reactive protein concentration >10 mg/L had a median survival of 26.2 months compared with 75.9 months in those patients with a C-reactive protein < or =10 mg/L (p < 0.05).


CONCLUSIONS
The results of this study indicate that the presence of a systemic inflammatory response predicts poor outcome in patients who have undergone potentially curative resection for lung cancer.
O'Dowd
Caroline
C
Department of Respiratory Medicine, Stobhill Hospital, Glasgow, UK. caroline.odowd@nhs.net
McRae
Laura A
LA
McMillan
Donald C
DC
Kirk
Alan
A
Milroy
Robert
R
D000230:Adenocarcinoma / Q000276:immunology / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D002289:Carcinoma, Non-Small-Cell Lung / Q000276:immunology / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000276:immunology / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018307:Neoplasms, Squamous Cell / Q000276:immunology / Q000401:mortality / Q000601:surgery; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D002097:C-Reactive Protein