title: Elevated serum C-reactive protein, carcinoembryonic antigen and N2 disease are poor prognostic indicators in non-small cell lung cancer.
abstract: OBJECTIVE
  To assess the prognostic value of mediastinal lymph node metastases (N2 disease), carcinoembryonic antigen (CEA) levels and C-reactive protein (CRP) in non-small cell lung cancer (NSCLC), according to the 7th edition of the TNM classification.
  
  
  METHODS
  Newly diagnosed stage III-IV NSCLC were enrolled, including 75 patients with malignant pleural effusion. The relationship between serum CRP levels and other relevant variables such as sex, Eastern Cooperative Oncology Group status, smoking status, initial staging, N2 disease, serum albumin, white blood cell count, platelet count, CEA, comorbidity and pathology were analyzed. Univariate and multivariate analyses were performed to find prognostic markers using Cox's proportional hazards model.
  
  
  RESULTS
  Of the 127 patients enrolled, 55 (43%) had elevated CRP levels. There was a significant correlation between serum CRP level and platelet count (P = 0.011). Median overall survival (OS) in the normal CRP group was significantly longer than in the high CRP group (15.7 months vs 9.1 months, P = 0.013). Hypoalbuminemia (P = 0.047), higher CEA (P = 0.043) and N2 disease (P = 0.040) were additional prognostic factors on univariate analysis. On multivariate analysis an elevated CRP serum level (HR = 1.796; P = 0.005), higher CEA (HR = 1.563; P = 0.031) and N2 disease (HR = 1.723; P = 0.012) were independent prognostic factors for poor survival.
  
  
  CONCLUSIONS
  High levels of serum CRP and CEA, and N2 disease are independent prognostic indicators for the survival of patients with stage III-IV NSCLC.
authors.affiliation: Department of Oncology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu Province, China.
authors.forename: Xue-Feng
authors.initials: XF
authors.lastname: Ni
authors.affiliation: Department of Pharmacology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu Province, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Wu
authors.affiliation: Department of Oncology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu Province, China.
authors.forename: Chang-Ping
authors.initials: CP
authors.lastname: Wu
authors.affiliation: Department of Oncology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu Province, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Ji
authors.affiliation: Department of Oncology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu Province, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Radiology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu Province, China.
authors.forename: Xiao-Fang
authors.initials: XF
authors.lastname: Gu
authors.affiliation: Department of Radiology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu Province, China.
authors.forename: Zhen-Xing
authors.initials: ZX
authors.lastname: Jiang
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000401:mortality / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D002272:Carcinoembryonic Antigen / Q000097:blood*; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood* / Q000401:mortality / Q000556:secondary*; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000401:mortality / Q000556:secondary; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012907:Smoking; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D002097:C-Reactive Protein
keywords: C-reactive protein; N2 disease; carcinoembryonic antigen; non-small cell lung cancer; survival analysis