title: Pretreatment C-reactive protein level predicts outcome and patterns of failure after chemoradiotherapy for locally advanced pancreatic cancer.
abstract: OBJECTIVE
  In this study we evaluated the predictive value of pretreatment C-reactive protein (CRP) levels on patterns of failure and survival outcomes in patients with locally advanced pancreatic cancer (LAPC) who received chemoradiotherapy (CRT).
  
  
  METHODS
  Data from 65 patients who underwent CRT for LAPC from July 2001 to May 2013 were retrospectively collected. Factors, including age, gender, Eastern Cooperative Oncology Group performance status (PS), histological confirmation, tumor size, tumor location, biliary drainage, stage, induction chemotherapy, CRP levels, neutrophil-to-lymphocyte ratio, platelet-lymphocyte ratio, albumin and carbohydrate antigen 19-9, were evaluated with regard to overall survival (OS) and patterns of failure using a Cox proportional hazards model.
  
  
  RESULTS
  The 1-year OS and median follow-up for all of the patients were 63.9% and 15.2 months, respectively. The median survival time and 1-year OS were 18.0 months and 72.5%, respectively, in the patients with lower CRP levels (≤3.0 mg/L), whereas 11.0 months and 30.8%, respectively, in the patients with higher CRP levels (>3.0 mg/L). Thirty-seven patients had tumor recurrence after CRT. All of the patients with higher CRP levels developed distant metastases as a primary sign of treatment failure. In a multivariate analysis, higher CRP levels were significantly correlated with distant disease-free survival (p = 0.004, HR = 4.50) and OS (p = 0.004, HR = 3.001). By contrast, local progression-free survival was not significantly different between the CRP subgroups.
  
  
  CONCLUSIONS
  The CRP levels were a significant predictor of survival and distant disease control for the LAPC patients who received CRT.
authors.affiliation: Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, 606-8507, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kishi
authors.affiliation: Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, 606-8507, Japan. Electronic address: akiran@kuhp.kyoto-u.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Nakamura
authors.affiliation: Department of Radiation Oncology, Kurashiki Central Hospital, Kurashiki, 710-0052, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Itasaka
authors.affiliation: Department of Therapeutic Radiology, Graduate School of Medicine, Yamaguchi University, Ube, 755-8505, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Shibuya
authors.affiliation: Department of Clinical Oncology and Pharmacogenomics, Kyoto University Graduate School of Medicine, Kyoto, 606-8507, Japan.
authors.forename: Shigemi
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: Department of Clinical Oncology and Pharmacogenomics, Kyoto University Graduate School of Medicine, Kyoto, 606-8507, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kanai
authors.affiliation: Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, 606-8507, Japan.
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Kodama
authors.affiliation: Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, 606-8507, Japan.
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Takaori
authors.affiliation: Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, 606-8507, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Mizowaki
authors.affiliation: Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, 606-8507, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hiraoka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism*; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; Chemoradiotherapy; Locally advanced pancreatic cancer; Patterns of failure; Survival