title: Preoperative serum C-reactive protein and its prognostic significance in patients with stage III-IV colorectal cancer.
abstract: The molecular mechanism underlying the development of colorectal cancer (CRC) is not yet fully-understood, but there is evidence that inflammation plays a key role. Several circulating tumor and inflammatory markers can be useful for studying patients with CRC. It has been suggested that high serum levels of C-reactive protein (CRP) are associated with elevated risk of various malignancies and that CRP may affect survival of patients with CRC. We analyzed the relationship existing between the stage of the disease and baseline CRP serum levels in a group of 91 patients undergoing surgery for stage III (N=72, 79.1%) and IVa (N=19, 20.9%) CRC. There were 51 (56%) men and 40 (44%) women, with a median age of 66 years. Prior to surgery, all patients underwent quantitative serum CRP measurement. The overall 5-year survival was 37.1 ± 13.0 months. Patients with stage III disease and the sub-group with CRP<3 mg/l (N=43, 47.3%) had a longer survival (p<0.01) than patients with stage IVa and the sub-group with CRP ≥ 3 mg/l (N=48, 52.7%). No relationship between the age of the patients and CRP levels was found (R=-0.005, p=0.96), whilst there was a significant inverse relationship between survival and CRP level (R=-0.37, y=37.5343-0.5868x, p=0.0003). Using multivariate Cox model analysis (forward stepwise method), adjusted for age, CRP and CRC stage were independent parameters related to survival, with a relative risk of 3.5 (95% confidence interval=1.5-8.2) and 8.1 (95% confidence interval=3.0-21.3), respectively. In conclusion, CRP is a sensitive and easily detectable serum marker that can be useful in patients with CRC, allowing their better clinical stratification.
authors.affiliation: Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, School of Medicine, Padova, Italy flumachi@unipd.it.
authors.forename: Franco
authors.initials: F
authors.lastname: Lumachi
authors.affiliation: Surgery 1, S. Maria degli Angeli Hospital, Pordenone, Italy.
authors.forename: Stefano M M
authors.initials: SM
authors.lastname: Basso
authors.affiliation: Medical Oncology, City Hospital, Alghero (SS), Italy.
authors.forename: Davide A
authors.initials: DA
authors.lastname: Santeufemia
authors.affiliation: Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, School of Medicine, Padova, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Ermani
authors.affiliation: Medical Oncology, S. Maria degli Angeli Hospital, Pordenone, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lo Re
authors.affiliation: Surgery 1, S. Maria degli Angeli Hospital, Pordenone, Italy.
authors.forename: Giordano B
authors.initials: GB
authors.lastname: Chiara
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D015179:Colorectal Neoplasms / Q000097:blood* / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D057234:Preoperative Period; D016016:Proportional Hazards Models; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D002097:C-Reactive Protein
keywords: C-Reactive protein; CRP; colorectal cancer; prognostic factors