title: Pretreatment serum C-reactive protein levels predict benefit from multimodality treatment including radical surgery in malignant pleural mesothelioma: a retrospective multicenter analysis.
abstract: OBJECTIVE
  To evaluate the prognostic and predictive relevance of pretreatment serum C-reactive protein (CRP) in malignant pleural mesothelioma (MPM) patients.
  
  
  BACKGROUND
  MPM is a rare but aggressive disease with poor treatment outcome. Therapeutic decision is challenging, and predictive biomarkers for better treatment stratification are urgently needed.
  
  
  METHODS
  Clinical data, including survival and pretreatment CRP levels, were retrospectively collected from 115 patients with histologically proven MPM. Patients with any evidence for infectious disease were excluded. The association between CRP levels and survival was analyzed using Cox models adjusted for clinical and pathological factors.
  
  
  RESULTS
  Median pretreatment CRP of all patients was 1.19 mg/dL (range: 0.00-22.62 mg/dL). Patients with elevated CRP levels (≥1 mg/dL; n = 62, 53.9%) had a significantly shorter overall survival compared with those with normal CRP (hazard ratio [HR] 2.81, 95% confidence interval [CI] 1.82-4.33; P < 0.001). In multivariate survival analyses, elevated CRP was confirmed as an independent prognostic factor in MPM (HR 2.07, 95% CI 1.23-3.46; P = 0.01). Most interestingly, we observed a significant interaction between CRP and treatment modality (P < 0.001). Among patients with normal CRP levels, radical tumor resection within multimodality therapy was associated with distinctly prolonged overall survival when compared with treatment protocols without surgery (HR 7.26, 95% CI 3.40-15.49; P < 0.001). In contrast among patients with elevated CRP, no survival benefit was achieved by radical surgery within multimodality approaches (HR 0.911, 95% CI 0.53-1.58; P = 0.74).
  
  
  CONCLUSIONS
  Our results suggest that multimodality regimens including radical resection increase survival selectively in MPM patients with normal pretreatment serum CRP levels.
authors: Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Austria.
authors: Bahil
authors: B
authors: Ghanim
authors: Mir Alireza
authors: MA
authors: Hoda
authors: Max-Paul
authors: MP
authors: Winter
authors: Thomas
authors: T
authors: Klikovits
authors: Arman
authors: A
authors: Alimohammadi
authors: Balazs
authors: B
authors: Hegedus
authors: Balazs
authors: B
authors: Dome
authors: Michael
authors: M
authors: Grusch
authors: Madeleine
authors: M
authors: Arns
authors: Peter
authors: P
authors: Schenk
authors: Wolfgang
authors: W
authors: Pohl
authors: Christoph
authors: C
authors: Zielinski
authors: Martin
authors: M
authors: Filipits
authors: Walter
authors: W
authors: Klepetko
authors: Walter
authors: W
authors: Berger
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000097:blood* / Q000401:mortality* / Q000601:surgery* / Q000628:therapy; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000097:blood* / Q000401:mortality* / Q000601:surgery* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D002097:C-Reactive Protein