title: Prognostic role of C-reactive protein in hepatocellular carcinoma: a systematic review and meta-analysis.
abstract: BACKGROUND
  C-reactive protein (CRP) which used to be a prototypical inflammatory cytokine has been identified involving in the progression of tumor-promoting inflammation. Several studies have indicated that CRP is a predictor for hepatocellular carcinoma (HCC), but the results are controversial.
  
  
  METHODS
  We conducted a systematic review of ten studies (1885 patients) to examine the association of high serum CRP expression with overall survival (OS) and recurrence-free survival (RFS) in HCC patients by meta-analysis. Moreover, the correlation between high serum CRP and tumor clinicopathological parameters was also assessed. Hazard ratio (HR) or odds ratio (OR) with its 95% confidence interval (CI) was used as the effect size estimate.
  
  
  RESULTS
  Our pooled results showed that high expression level of serum CRP (≥ 10 mg/L) was associated with poor OS (HR: 2.15, 95% CI: 1.76-2.63) and RFS (HR: 2.66, 95% CI: 1.54-4.58) in HCC. Serum CRP overexpression (≥ 10 mg/L) was also significantly associated with the presence of tumor vascular invasion (OR: 3.05, 95% CI: 1.79-5.23), multiple tumor (OR: 2.36, 95% CI: 1.36-4.10), larger tumor size (OR: 3.41, 95% CI: 1.04-11.18), and advanced TNM stage (OR: 3.23, 95% CI: 2.29-4.57). In addition, serum CRP overexpression (≥ 10 mg/L) tended to be correlated with poor differentiation (OR: 1.58, 95% CI: 0.74-3.39), though not significantly.
  
  
  CONCLUSIONS
  The present systematic review and meta-analysis demonstrate that high serum level of CRP (≥ 10 mg/L) denotes a poor prognosis of patients with HCC.
authors.affiliation: Key Lab of Multi-organ Transplantation, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, PR China.
authors.forename: Zhiyun
authors.initials: Z
authors.lastname: Zheng
authors.forename: Lin
authors.initials: L
authors.lastname: Zhou
authors.forename: Sheng
authors.initials: S
authors.lastname: Gao
authors.forename: Zhe
authors.initials: Z
authors.lastname: Yang
authors.forename: Jia
authors.initials: J
authors.lastname: Yao
authors.forename: Shusen
authors.initials: S
authors.lastname: Zheng
mesh_terms: D002097:C-Reactive Protein; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000473:pathology; D018572:Disease-Free Survival; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000473:pathology; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D039781:PubMed
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; hepatocellular carcinoma; prognosis; survival.