title: Validation of C-reactive protein levels as a prognostic indicator for survival in a large cohort of pancreatic cancer patients.
abstract: BACKGROUND
  Recent evidence indicates that the host inflammatory response has an important role in the tumour progression. Elevated C-reactive protein (CRP) levels have been previously associated with poor prognosis in several cancer types including small-scale studies in pancreatic cancer (PC) patients. The purpose of the present study was to validate the prognostic impact of plasma CRP levels at date of diagnosis on cancer-specific survival (CSS) in a large cohort of PC patients.
  
  
  METHODS
  Data from 474 consecutive patients with adenocarcinoma of the pancreas, treated between 2004 and 2012 at a single centre, were evaluated retrospectively. CSS was analysed using the Kaplan-Meier method. To evaluate the prognostic significance of plasma CRP levels, univariate and multivariate Cox analyses were applied.
  
  
  RESULTS
  High plasma CRP levels at diagnosis were significantly associated with well-established prognostic factors, including high tumour stage and tumour grade and the administration of chemotherapy (P<0.05). In univariate analysis, we observed that a high plasma CRP level was a consistent factor for poor CSS in PC patients (hazard ratio (HR)=2.21; 95% confidence interval (CI)=1.68-2.92, P<0.001). In multivariate analysis, tumour stage, grade, administration of chemotherapy, a high neutrophil-lymphocyte ratio and the highest quartile of CRP levels (HR=1.60, 95% CI=1.16-2.21; P=0.005) were identified as independent prognostic factors in PC patients.
  
  
  CONCLUSIONS
  In conclusion, we confirmed a significant association of elevated CRP levels with poor clinical outcome in PC patients. Our results indicate that the plasma CRP level might represent a useful marker for patient stratification in PC management.
authors.affiliation: Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Szkandera
authors.affiliation: Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Stotz
authors.affiliation: Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Absenger
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
authors.forename: T
authors.initials: T
authors.lastname: Stojakovic
authors.affiliation: Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Samonigg
authors.affiliation: Division of General Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
authors.forename: P
authors.initials: P
authors.lastname: Kornprat
authors.affiliation: Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Schaberl-Moser
authors.affiliation: Institute of Pathology, Medical University of Graz, Graz, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Alzoughbi
authors.affiliation: Institute of Pathology, Medical University of Graz, Graz, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Lackner
authors.affiliation: Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
authors.forename: A L
authors.initials: AL
authors.lastname: Ress
authors.affiliation: Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
authors.forename: F S
authors.initials: FS
authors.lastname: Seggewies
authors.affiliation: 1] Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria [2] Research Unit Genetic Epidemiology and Pharmacogenetics, Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Gerger
authors.affiliation: Institute of Pathology, Medical University of Graz, Graz, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Hoefler
authors.affiliation: Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Pichler
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood* / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: D002097:C-Reactive Protein