title: C-reactive protein level is a prognostic indicator for survival and improves the predictive ability of the R-IPI score in diffuse large B-cell lymphoma patients.
abstract: BACKGROUND
  High levels of C-reactive protein (CRP), an acute phase protein, proofed being associated with decreased clinical outcome in small-scale studies in diffuse large B-cell lymphoma (DLBCL). The aim of this study was to evaluate the prognostic impact of pretreatment CRP levels on overall survival (OS) and disease-free survival (DFS) in a large bicentre study of DLBCL patients.
  
  
  METHODS
  Data from 477 DLBCL patients, diagnosed and treated between 2004 and 2013 at two Austrian centres, were evaluated retrospectively. The prognostic influence of CRP and other factors, including age, tumour stage, and revised International Prognostic Index (R-IPI) on 5-year OS and 5-year DFS, were studied by Kaplan-Meier curves as well as univariate and multivariate Cox regression models. Influence of CRP on the predictive accuracy of the R-IPI score was determined by the Harrell concordance index.
  
  
  RESULTS
  Kaplan-Meier curves revealed elevated CRP as a factor for decreased 5-year OS and DFS in DLBCL patients (P<0.001, log-rank test). An independent significant association between high CRP levels and poor clinical outcome in multivariate analysis for 5-year OS (HR=1.51, CI 95%=1.04-2.20, P=0.031) and for DFS (HR=1.91, CI 95%=1.28-2.85, P=0.002) was found. The estimated concordance index was 0.75 using the original R-IPI score and 0.79 when CRP was added.
  
  
  CONCLUSIONS
  In the present study, we demonstrated high CRP levels at diagnosis of DLBCL as an independent poor prognostic factor for clinical outcome. Adding CRP to the well-established prognostic models such as the R-IPI score might improve their predictive ability.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria.
authors.forename: K T
authors.initials: KT
authors.lastname: Troppan
authors.affiliation: Third Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.
authors.forename: K
authors.initials: K
authors.lastname: Schlick
authors.affiliation: Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Deutsch
authors.affiliation: Third Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.
authors.forename: T
authors.initials: T
authors.lastname: Melchardt
authors.affiliation: Third Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Egle
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz (MUG), Graz, Austria.
authors.forename: T
authors.initials: T
authors.lastname: Stojakovic
authors.affiliation: Institute of Pathology, Medical University of Graz (MUG), Graz, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Beham-Schmid
authors.affiliation: Third Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.
authors.forename: L
authors.initials: L
authors.lastname: Weiss
authors.affiliation: Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria.
authors.forename: D
authors.initials: D
authors.lastname: Neureiter
authors.affiliation: Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria.
authors.forename: K
authors.initials: K
authors.lastname: Wenzl
authors.affiliation: Third Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Greil
authors.affiliation: Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria.
authors.forename: P
authors.initials: P
authors.lastname: Neumeister
authors.affiliation: 1] Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston 77030, TX, USA [2] Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Pichler
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000378:metabolism*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood* / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D002097:C-Reactive Protein