title: The addition of C-reactive protein to validated staging systems improves their prognostic ability in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  C-reactive protein (CRP) is a practical prognostic marker in patients with hepatocellular carcinoma (HCC). We investigated the prognostic value of adding the CRP level to other validated staging systems (Cancer Liver Italian Program, Japan Integrated Staging, Barcelona Clinic Liver Cancer classification system, Tokyo score and tumor node metastasis classification) in HCC patients.
  
  
  METHODS
  One hundred and eighty-six newly diagnosed HCC patients were retrospectively evaluated. A multivariate analysis identified the clinicopathological variables associated with overall survival; the variables identified were then added to each staging system and compared to those without the additional variable.
  
  
  RESULTS
  In multivariate analysis, an elevated serum CRP level was independently associated with a poor prognosis (hazard ratio 3.792, p < 0.0001). The addition of the CRP level to each of the established staging systems provided a higher linear χ(2) value and a lower -2 log likelihood than those without the addition of the term. Moreover, the area under the receiver-operating characteristic curve (AUC) analysis showed that the addition of CRP improved the AUC of each staging system.
  
  
  CONCLUSIONS
  This study demonstrates that an elevated serum CRP level is independently associated with a poor prognosis in HCC patients, and the addition of the CRP level to the validated staging systems could improve the prognostic ability of each staging system.
authors.affiliation: Division of Gastroenterology and Hepatology, Jikei University Daisan Hospital, Tokyo, Japan.
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Kinoshita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Onoda
authors.forename: Nami
authors.initials: N
authors.lastname: Imai
authors.forename: Akira
authors.initials: A
authors.lastname: Iwaku
authors.forename: Mutumi
authors.initials: M
authors.lastname: Oishi
authors.forename: Ken
authors.initials: K
authors.lastname: Tanaka
authors.forename: Nao
authors.initials: N
authors.lastname: Fushiya
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Nishino
authors.forename: Masato
authors.initials: M
authors.lastname: Matsushima
authors.forename: Hisao
authors.initials: H
authors.lastname: Tajiri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D002097:C-Reactive Protein