title: Prognostic significance of C-reactive protein in urological cancers: a systematic review and meta-analysis.
abstract: BACKGROUND
  C-reactive protein (CRP), considered as a prototypical inflammatory cytokine, has been proposed to be involved in tumor progression through inflammation. Recent studies have indicated CRP as a progostic predictor for urological cancers, but the results remain controversial.
  
  
  METHODS
  A systematic search of Medline, Scopus and the Cochrane Library was performed to identify eligible studies published between Jan 1, 2001 and Sep 1, 2013. Outcomes of interest were collected from studies comparing overall survival (OS), cancer-specific survival (CSS) and relapse-free survival (RFS) in patients with elevated CRP levels and those having lower levels. Studies were pooled, and combined hazard ratio (HR) of CRP with its 95% confidence interval (CI) for survival were used for the effect size estimate.
  
  
  RESULTS
  A total of 43 studies (7,490 patients) were included in this meta-analysis (25 for RCC, 10 for UC, and 8 for PC). Our pooled results showed that elevated serum CRP level was associated with poor OS (HR: 1.26, 95%CI: 1.22-1.30) and RFS (HR: 1.38 95%CI: 1.29-1.47), respectively. For CSS the pooled HR (HR: 1.33, 95%CI: 1.28-1.39) for higher CRP expression could strongly predict poorer survival in urological cancers. Simultaneously, elevated serum CRP was also significantly associated with poor prognosis in the subgroup analysis.
  
  
  CONCLUSIONS
  Our pooled results demonstrate that a high serum level of CRP as an inflammation biomarker denotes a poor prognosis of patients with urological cancers. Further large prospective studies should be performed to confirm whether CRP, as a biomarker of inflammation, has a prognostic role in urological cancer progression.
authors.affiliation: Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China E-mail : xuhuawhu@163.com.
authors.forename: Jin
authors.initials: J
authors.lastname: Dai
authors.forename: Kun
authors.initials: K
authors.lastname: Tang
authors.forename: Wei
authors.initials: W
authors.lastname: Xiao
authors.forename: Gan
authors.initials: G
authors.lastname: Yu
authors.forename: Jin
authors.initials: J
authors.lastname: Zeng
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Ya-Qun
authors.initials: YQ
authors.lastname: Zhang
authors.forename: Hua
authors.initials: H
authors.lastname: Xu
authors.forename: Zhi-Qiang
authors.initials: ZQ
authors.lastname: Chen
authors.forename: Zhang-Qun
authors.initials: ZQ
authors.lastname: Ye
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism*; D002277:Carcinoma / Q000175:diagnosis / Q000378:metabolism*; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000378:metabolism; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000378:metabolism; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000378:metabolism*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000378:metabolism*; D011379:Prognosis; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000378:metabolism*; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000378:metabolism*
chemical_list: D014408:Biomarkers, Tumor; D002097:C-Reactive Protein