title: Elevated preoperative systemic inflammatory markers predict poor outcome in localized soft tissue sarcoma.
abstract: BACKGROUND
  Systemic inflammation has been implicated in cancer development and progression. This study sought to determine whether systemic inflammatory markers can predict postoperative outcome in soft tissue sarcoma (STS).
  
  
  METHODS
  A total of 162 cases of primary, localized STS were reviewed. Patients with evidence of infectious or inflammatory diseases were excluded. The mean follow-up period was 46.7 months. The level of serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil-to-lymphocyte ratio (NLR) measured before surgery were evaluated for association with disease-specific survival and local recurrence.
  
  
  RESULTS
  The mean values of CRP, ESR, and NLR were 0.79 mg/dL, 18.8 mm/h, and 2.12, respectively. Cutoff values derived from receiver-operating characteristic curve analysis were 0.20 mg/dL for CRP, 10.0 mm/h for ESR, and 2.50 for NLR. On univariate analysis, all inflammatory markers were associated with disease-specific survival (CRP: P = 0.007; ESR: P = 0.022; NLR: P = 0.030). On multivariate analysis, the CRP level (P = 0.019) and ESR (P = 0.013) remained significant. Elevation of multiple markers was a more significant prognostic factor than elevation of a single marker (P = 0.001). However, none of the inflammatory markers was associated with local recurrence (CRP: P = 0.345; ESR: P = 0.271; NLR: P = 0.570). Histologic grade was strongly correlated with inflammatory marker values (NLR: P < 0.001; ESR: P = 0.002; CRP: P = 0.007).
  
  
  CONCLUSIONS
  Preoperative systemic inflammatory status, assessed by using multiple serum markers, predicted disease-specific survival in STS.
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Eun-Seok
authors.initials: ES
authors.lastname: Choi
authors.forename: Han-Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Ilkyu
authors.initials: I
authors.lastname: Han
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism*; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012509:Sarcoma / Q000378:metabolism* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D018836:Inflammation Mediators; D002097:C-Reactive Protein