title: C-Reactive Protein Level Is an Indicator of the Aggressiveness of Advanced Pancreatic Cancer.
abstract: OBJECTIVE
  This study investigated the ability of serum levels of C-reactive protein (CRP) to stratify the aggressiveness of advanced pancreatic cancer (PCa), including poor outcomes, systemic weakness, and extent of the disease in patients receiving first-line chemotherapy.
  
  
  METHODS
  The prognostic CRP classification was constructed in the retrospective cohort, consisting of advanced PCa patients with first-line gemcitabine monotherapy (GEM). Stratification using the prognostic CRP classification was validated for relationships with the aggressiveness of advanced PCa in the prospective cohort, consisting of treatment-naive patients without obvious infections who received first-line GEM or GEM-based regimens.
  
  
  RESULTS
  C-reactive protein low (<0.5 mg/dL), intermediate (≥ 0.5 and <2.0 mg/dL), and high (≥ 2.0 mg/dL) related good, moderate, and poor survival, respectively, and were independent predictors of survival in multivariate analyses among the 280 patients in the retrospective cohort and the 141 patients in the prospective cohort. Low Karnofsky Performance Status, hypoalbuminemia, anemia, and large tumor burden were more common in the high CRP group than in the low CRP group. The intermediate CRP group showed a larger burden of tumor than the low CRP group.
  
  
  CONCLUSIONS
  C-reactive protein stratified the outcomes, systemic weakness, and tumor burden. C-reactive protein is an indicator of the aggressiveness of advanced PCa.
authors.affiliation: From the *Department of Hepatobiliary and Pancreatic Oncology and †Pathology Division, Research Center for Innovative, National Cancer Center Hospital East, Kashiwa, Chiba; and ‡Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Chuo-ku, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Mitsunaga
authors.forename: Masafumi
authors.initials: M
authors.lastname: Ikeda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shimizu
authors.forename: Izumi
authors.initials: I
authors.lastname: Ohno
authors.forename: Hideaki
authors.initials: H
authors.lastname: Takahashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okuyama
authors.forename: Hideki
authors.initials: H
authors.lastname: Ueno
authors.forename: Chigusa
authors.initials: C
authors.lastname: Morizane
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kondo
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Takuji
authors.initials: T
authors.lastname: Okusaka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ochiai
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism*; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006304:Health Status; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000145:classification / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D014408:Biomarkers, Tumor; D003841:Deoxycytidine; D002097:C-Reactive Protein; D000093542:Gemcitabine