title: C-Reactive Protein as a New Prognostic Factor for Survival in Patients With Pancreatic Neuroendocrine Neoplasia.
abstract: BACKGROUND
  Patients with pancreatic neuroendocrine neoplasia (pNEN) show great variability in prognosis and treatment response. Additional prognostic markers might help in individual therapeutic decision making.
  
  
  OBJECTIVE
  The objective of the study was to investigate the association between preoperative plasma levels of C-reactive protein (CRP) and overall survival (OS) in pNEN.
  
  
  METHODS
  This was a single-center, retrospective analysis of long-term prospective patient-database.
  
  
  METHODS
  The study was conducted at a tertiary referral center.
  
  
  METHODS
  All 149 patients with sporadic pNENs were eligible for retrospective analysis.
  
  
  METHODS
  Cumulative overall survival, compared between patients with elevated and normal CRP levels, was measured.
  
  
  RESULTS
  Median OS for patients with elevated CRP levels was 1093 days (SE 1261, 95% confidence interval [CI] 0-3565), compared with 6859 days (SE 1252, 95% CI 4405-9313) for patients with normal CRP levels. Log rank test showed a significant correlation between CRP and OS (P < .001). In univariate Cox regression, patients with elevated CRP levels had a significantly higher hazard ratio for death (3.27; 95%-CI 1.74-6.16; P < .001). This finding persisted after multivariable adjustment. Furthermore, OS was associated with the presence of liver metastases (hazard ratio 3.17; 95% CI 1.88-5.35; P < .001), incomplete resection (R1/R2 status; hazard ratio 3.99; 95% CI 2.16-7.35; P < .001) and Ki-67 percentage (hazard ratio 5.05; 95% CI 2.17-11.76; P < .001).
  
  
  CONCLUSIONS
  CRP is an independent prognostic marker in patients with pNEN. Pretreatment CRP measurements should be considered for incorporation into prospective studies of outcome in patients with pNENs and clinical trials of systemic therapies for these tumors.
authors.affiliation: Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Marburg, 35033 Marburg, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Wiese
authors.affiliation: Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Marburg, 35033 Marburg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Kampe
authors.affiliation: Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Marburg, 35033 Marburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Waldmann
authors.affiliation: Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Marburg, 35033 Marburg, Germany.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Heverhagen
authors.affiliation: Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Marburg, 35033 Marburg, Germany.
authors.forename: Detlef K
authors.initials: DK
authors.lastname: Bartsch
authors.affiliation: Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Marburg, 35033 Marburg, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Fendrich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000401:mortality* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein