title: Intrahepatic cholangiocarcinoma prognostic determination using pre-operative serum C-reactive protein levels.
abstract: Serum C-reactive protein (CRP), an acute inflammatory response biomarker, has been recognized as an indicator of malignant disease progression. However, the prognostic significance of CRP levels collected before tumor removal in intrahepatic cholangiocarcinoma requires further investigation.
  
  
  
  We sampled the CRP levels in 140 patients with intrahepatic cholangiocarcinoma who underwent hepatectomies with regional lymphadenectomies between 2006 and 2013. A retrospective analysis of the clinicopathological data was performed. We focused on the impact of serum CRP on the patients' cancer-specific survival and recurrence-free survival rates.
  
  
  
  High levels of preoperative serum CRP were significantly associated with well-established clinicopathologic features, including gender, advanced tumor stage, and elevated carcinoembryonic antigen and carbohydrate antigen 19-9 levels (P < 0.05). Univariate analysis demonstrated a significant association between high levels of serum CRP and adverse cancer-specific survival (P = 0.001) and recurrence-free survival (P < 0.001). In patients with stage I/II intrahepatic cholangiocarcinoma, the serum CRP level was a prognostic indicator for cancer-specific survival. In patients with stage I/II or stage III/IV, the serum CRP level was a prognostic indicator for recurrence-free survival (P < 0.05). Additionally, multivariate analysis identified serum CRP level in intrahepatic cholangiocarcinoma as an independent prognostic factor (P < 0.05).
  
  
  
  We confirmed a significant association of elevated pre-operative CRP levels with poor clinical outcomes for the tested patients with intrahepatic cholangiocarcinoma. Our results indicate that the serum CRP level may represent a useful factor for patient stratification in intrahepatic cholangiocarcinoma management.
authors.affiliation: Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.|Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China.
authors.forename: Zi-Ying
authors.initials: ZY
authors.lastname: Lin
authors.affiliation: Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.|Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China.
authors.forename: Zhen-Xing
authors.initials: ZX
authors.lastname: Liang
authors.affiliation: Department of Prosthodontics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Pei-Lin
authors.initials: PL
authors.lastname: Zhuang
authors.affiliation: Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.|Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China.
authors.forename: Jie-Wei
authors.initials: JW
authors.lastname: Chen
authors.affiliation: Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.|Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Department of Pathology and Laboratory Medicine, Guangdong General Hospital, Guangzhou, China.
authors.forename: Li-Xu
authors.initials: LX
authors.lastname: Yan
authors.affiliation: Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.|Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China.
authors.forename: Jing-Ping
authors.initials: JP
authors.lastname: Yun
authors.affiliation: Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.|Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Xie
authors.affiliation: Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. caimuyan@hotmail.com.|Department of Pathology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road East, 510060, Guangzhou, China. caimuyan@hotmail.com.
authors.forename: Mu-Yan
authors.identifier: 0000-0001-5315-8336
authors.initials: MY
authors.lastname: Cai
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000097:blood* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015415:Biomarkers; D014408:Biomarkers, Tumor; D002097:C-Reactive Protein; D018281:Cholangiocarcinoma / Q000097:blood* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D057234:Preoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve
chemical_list: D015415:Biomarkers; D014408:Biomarkers, Tumor; D002097:C-Reactive Protein
keywords: C-reactive protein; Intrahepatic cholangiocarcinoma; Prognosis