title: The prognostic role of systemic inflammation in patients undergoing resection of colorectal liver metastases: C-reactive protein (CRP) is a strong negative prognostic biomarker.
abstract: OBJECTIVE
  Systemic inflammation has been associated with poor survival in several tumor types, but has been less extensively studied in resectable metastatic disease. The aim of the present study was to evaluate the prognostic role of CRP in colorectal cancer patients with liver metastases (CRLM) compared to conventional tumor- and patient-related clinicopathological features as well as other indicators of the systemic inflammatory response (SIR).
  
  
  METHODS
  A multinational retrospective study of 492 CRLM patients undergoing potentially curative resection of liver metastases between 1999 and 2009. Clinicopathological findings and the SIR markers CRP, hypoalbuminemia, and their combined Glasgow Prognostic Score (GPS) were analyzed.
  
  
  RESULTS
  Multivariate analysis showed that preoperative CRP >10 mg/L was a strong predictor of compromised survival (HR = 1.72, 95%CI 1.84-2.50, P < 0.01). Patients with CRP ≤10 mg/L had a median survival of 4.27 years compared to only 47 days in patients with CRP ≥30 mg/L (P < 0.01). Similarly, increased GPS was independently predictive of poor survival (HR 1.67, 95%CI 1.22-2.27, P < 0.01), but hypoalbuminemia alone did not have significant prognostic value.
  
  
  CONCLUSIONS
  CRP alone is a strong prognostic factor, following curative resection of colorectal liver metastases and should be taken into consideration when selecting treatment strategies in CRLM patients. J. Surg. Oncol. 2016;114:895-899. © 2016 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Oncology, Southern Hospital Trust, Kristiansand, Norway. ankoes@sshf.no.
authors.forename: Anne Helene
authors.initials: AH
authors.lastname: Køstner
authors.affiliation: Department of Oncology, Southern Hospital Trust, Kristiansand, Norway.
authors.forename: Christian
authors.initials: C
authors.lastname: Kersten
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
authors.forename: Thyra
authors.initials: T
authors.lastname: Löwenmark
authors.affiliation: Division of Surgery, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute at Karolinska University Hospital, Huddinge, Sweden.
authors.forename: Karin A
authors.initials: KA
authors.lastname: Ydsten
authors.affiliation: Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.|Research Programs Unit, Translational Cancer Biology, University of Helsinki, Finland.
authors.forename: Reetta
authors.initials: R
authors.lastname: Peltonen
authors.affiliation: Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Helena
authors.initials: H
authors.lastname: Isoniemi
authors.affiliation: Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.|Research Programs Unit, Translational Cancer Biology, University of Helsinki, Finland.
authors.forename: Caj
authors.initials: C
authors.lastname: Haglund
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Gunnarsson
authors.affiliation: Division of Surgery, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute at Karolinska University Hospital, Huddinge, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Isaksson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism*; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor; D002097:C-Reactive Protein
keywords: C-reactive protein; Glasgow prognostic score; colorectal cancer; liver metastases; systemic inflammatory response