title: Persistent elevated C-reactive protein after treatment is an independent marker of a poor prognosis in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  The pretreatment C-reactive protein (CRP) level is reported to be a prognostic indicator in patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  We investigated the prognostic implications of the changes in the CRP level after initial treatment in patients with HCC. We prospectively evaluated a cohort of 150 patients with newly diagnosed HCC. The patients were categorized into three groups: group 1 (n = 120) with pre- and post-treatment CRP <1.0 mg/dl, group 2 (n = 5) with pre-treatment CRP ≥1.0 mg/dl and post-treatment CRP <1.0 mg/dl, and group 3 (n = 25) with pre- and post-treatment CRP ≥1.0 mg/dl.
  
  
  RESULTS
  The 1- and 3-year overall survival rates were 92.3 and 82.9 % for group 1, 80.0 and 53.3 % for group 2, and 58.8 and 4.2 % for group 3. The overall survival rate for group 3 was significantly lower than that for group 1 (P < 0.0001), or group 2 (P = 0.003). No significant difference was found between groups 1 and 2 (P = 0.627). A multi-variate analysis showed that albumin level (P = 0.049), the CRP group (P < 0.0001), and the Cancer of the Liver Italian Program (CLIP) score (P < 0.0001) were independently associated with the overall survival.
  
  
  CONCLUSIONS
  A persistently elevated CRP level after initial treatment is an independent marker of a poor prognosis, and normalization of the CRP level after initial treatment is associated with a better outcome in patients with HCC.
authors.affiliation: Division of Gastroenterology and Hepatology, The Jikei University Daisan Hospital, 4-11-1 Izumihon-cho, Komae, Tokyo, 201-8601, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Imai
authors.forename: A
authors.initials: A
authors.lastname: Kinoshita
authors.forename: H
authors.initials: H
authors.lastname: Onoda
authors.forename: A
authors.initials: A
authors.lastname: Iwaku
authors.forename: M
authors.initials: M
authors.lastname: Oishi
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.forename: N
authors.initials: N
authors.lastname: Fushiya
authors.forename: K
authors.initials: K
authors.lastname: Koike
authors.forename: H
authors.initials: H
authors.lastname: Nishino
authors.forename: H
authors.initials: H
authors.lastname: Tajiri
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000378:metabolism* / Q000473:pathology; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000378:metabolism* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor; D002097:C-Reactive Protein