Baseline C-reactive protein level predicts survival of early-stage lung cancer: evidence from a systematic review and meta-analysis.
OBJECTIVE
The prognostic impact of baseline C-reactive protein (CRP) in non-small-cell lung cancer (NSCLC) is debated. To evaluate this issue, we performed a systematic review and meta-analysis to explore the role of CRP value in predicting early-stage NSCLC survival.


METHODS
Ten articles on early-stage NSCLC were eligible and included in our study. We performed a random-effects meta-analysis and assessed heterogeneity and publication bias. We pooled hazard ratio (HR) estimates and their 95% confidence intervals (CIs) on mortality for the comparison between the study-specific highest category of CRP level versus the lowest one.


RESULTS
In overall analysis, elevated pretreatment CRP values were significantly associated with poor overall survival (HR 1.60, 95% CI 1.30-1.97, p&lt;0.001, I2 = 71.9%). Similar results were observed across considered strata. However, higher mortality risk was reported in studies in which CRP was combined with other factors (HR 1.96, 95% CI 1.58-2.45) and in those using a cutoff value of 3 mg/L (HR 1.89, 95% CI 1.52-2.35).


CONCLUSIONS
Based on our analysis, baseline high CRP level is significantly associated with poor prognosis in early-stage NSCLC. Further prospective controlled studies are needed to confirm these data.
Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
Giovanni
G
Leuzzi
Department of Clinical Sciences and Community Health, University of Milan, Milan - Italy.
Carlotta
C
Galeone
Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
Mara
M
Gisabella
Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
Leonardo
L
Duranti
Immunohematology and Transfusion Medicine Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
Francesca
F
Taverna
Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
Paola
P
Suatoni
Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
Daniele
D
Morelli
Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
Ugo
U
Pastorino
D014408:Biomarkers, Tumor; D002097:C-Reactive Protein; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood / Q000401:mortality / Q000473:pathology; D003131:Combined Modality Therapy; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D016017:Odds Ratio; D011379:Prognosis
D014408:Biomarkers, Tumor; D002097:C-Reactive Protein