title: Clinical Implications of C-Reactive Protein as a Prognostic Marker in Advanced Cancer Patients in Palliative Care Settings.
abstract: Plasma C-reactive protein (CRP) levels are elevated in patients with advanced cancer.
  
  
  
  To investigate CRP as a prognostic marker in palliative settings.
  
  
  
  This multicenter prospective cohort study comprised 2426 patients. Laboratory data were obtained at baseline, and all patients were followed until death or six months after their enrollment. A total of 1511 patients were eligible for the analyses. They were divided into four groups: low-CRP (CRP < 1 mg/dL), moderate-CRP (1 ≤ CRP <5 mg/dL), high-CRP (5 ≤ CRP <10 mg/dL), and very high-CRP (10 mg/dL ≤ CRP) groups. Survival was investigated by the Kaplan-Meier method with the log-rank test. The 30-, 60-, and 90-day mortality rates were tested by Chi-squared tests. Univariate- and multivariate-adjusted hazard ratios (HRs) and 95% CIs in each group were calculated using Cox proportional hazard models.
  
  
  
  Survival rate decreased and mortality rate increased with increasing CRP level. The differences in survival and 30-, 60-, and 90-day mortality rates among the groups were statistically significant (P < 0.001). Baseline CRP level was significantly associated with a higher risk of mortality after adjustment for age, gender, primary tumor site, metastasis, chemotherapy, Eastern Cooperative Oncology Group Performance Status, and setting of care (moderate-CRP: HR 1.47 [95% CI 1.24-1.73], high-CRP: HR 2.09 [95% CI 1.74-2.50], and very high-CRP: HR 2.55 [95% CI 2.13-3.05] vs. low-CRP).
  
  
  
  Clear dose-effect relationships between elevated CRP levels and prognoses indicate that CRP could be useful in predicting prognoses in patients with advanced cancer.
authors.affiliation: Department of Palliative Medicine, Osaka City General Hospital, Osaka City, Osaka, Japan. Electronic address: kojiamano4813@gmail.com.
authors.forename: Koji
authors.initials: K
authors.lastname: Amano
authors.affiliation: Department of Palliative Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
authors.forename: Isseki
authors.initials: I
authors.lastname: Maeda
authors.affiliation: Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.affiliation: Department of Palliative Medicine, National Cancer Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Miura
authors.affiliation: Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Inoue
authors.affiliation: Children's Hospice Hospital, Yodogawa Christian Hospital, Osaka City, Osaka, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ikenaga
authors.affiliation: Department of Palliative Medicine, National Cancer Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Department of Palliative Care, Saito Yukoukai Hospital, Ibaragi, Osaka, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Baba
authors.affiliation: Department of Pain and Palliative Care, Kameda Medical Center, Kamogawa, Chiba, Japan.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Sekine
authors.affiliation: Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Palliative Care, Mitui Memorial Hospital, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hirohashi
authors.affiliation: Department of Palliative Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Tajima
authors.affiliation: Department of Palliative Medicine, Osaka City General Hospital, Osaka City, Osaka, Japan.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Tatara
authors.affiliation: Department of Palliative Medicine, Komaki City Hospital, Komaki, Aichi, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Watanabe
authors.affiliation: Department of Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center, Fukuoka City, Fukuoka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Otani
authors.affiliation: Department of Palliative Care, KKR Sapporo Medical Center, Sapporo, Hokkaido, Japan.
authors.forename: Chizuko
authors.initials: C
authors.lastname: Takigawa
authors.affiliation: Department of Psychosomatic Medicine, National Hospital, Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Matsuda
authors.affiliation: Department of Medical Social Service Center for Palliative and Supportive Care, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Hiroka
authors.initials: H
authors.lastname: Nagaoka
authors.affiliation: Department of Palliative Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Mori
authors.affiliation: Department of Palliative Medicine, National Cancer Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kinoshita
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D010166:Palliative Care; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: C-reactive protein; advanced cancer patients; palliative setting; prognostic marker