title: Prognostic impact of C-reactive protein in metastatic prostate cancer: a systematic review and meta-analysis.
abstract: BACKGROUND
  Serum C-reactive protein (CRP) demonstrates a prognostic impact in small studies of metastatic prostate cancer (MPC).
  
  
  METHODS
  A systematic review was conducted to identify publications and presentations exploring the association of serum CRP and overall survival (OS) in MPC, both castration-sensitive and castration-resistant. Heterogeneity among trials was assessed using Cochrane's Q statistic, and the I(2) statistic was used to quantify inconsistency. The assumption of homogeneity was considered invalid if p < 0.1. All statistical tests were 2-sided, and p < 0.05 was considered significant.
  
  
  RESULTS
  6 studies were eligible, totaling 659 evaluable patients. 2 studies evaluated castration-sensitive men receiving androgen deprivation, while the remaining 4 studies evaluated castration-resistant men receiving docetaxel-based chemotherapy. Men with higher CRP had significantly worse OS than those with lower CRP (hazard ratio (HR) = 1.42, p < 0.001, 95% confidence interval (CI) 1.17-1.73). In trials of castration-sensitive men, high CRP yielded a HR = 1.92 (p = 0.005, 95% CI 1.22-3.03; I(2) = 0). In castration-resistant men, high CRP yielded HR = 1.35 (p = 0.003, 95% CI 1.11-1.65; I(2) = 78.6%).
  
  
  CONCLUSIONS
  This meta-analysis suggests a detrimental impact for CRP on OS in MPC. Prospective validation is justified to enhance prognostication and trial design, given the affordability, ready availability, and large dynamic range of CRP.
authors.affiliation: Medical Oncology Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Rocha
authors.forename: Charity J
authors.initials: CJ
authors.lastname: Morgan
authors.forename: Arnoud J
authors.initials: AJ
authors.lastname: Templeton
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Pond
authors.forename: Gurudatta
authors.initials: G
authors.lastname: Naik
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism*; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000097:blood* / Q000401:mortality; D015996:Survival Rate
chemical_list: D002097:C-Reactive Protein