title: C-reactive protein (CRP) as a prognostic factor for colorectal cancer after surgical resection of pulmonary metastases.
abstract: BACKGROUND
  Pulmonary metastases occur in up to 25% of colorectal cancer (CRC) patients. Many studies have reported that pulmonary metastasectomy might increase 5-year survival of these patients. The aim of this study was to describe our experience with pulmonary metastasectomy for metastatic colorectal cancer and to explore the prognostic value of serum C-reactive protein (CRP) and other factors.
  
  
  METHODS
  Between June 2002 and December 2013, the clinicopathological data of 88 patients who underwent resection of pulmonary metastases from colorectal carcinoma were retrospectively reviewed and analyzed. Clinical, investigative and operative data were prospectively collected. Overall survival (OS) was calculated from resection of pulmonary metastases to death.
  
  
  RESULTS
  There were 58 men and 30 women in this study, and their median age was 55 (range 31 to 85). Video-assisted thoracoscopic surgery (VATS) was performed in 59 cases (78%) and 29 patients (19%) underwent thoracotomy. Lung wedge resection and pulmonary lobectomy were performed in 52 (59.1%) and 36 patients (40.9%), respectively. Preoperative elevated CRP was present in 8 (9.1%) patients. After a median follow-up duration of 44 months, the cumulative 5-year survival was 45.4% and the median overall survival (OS) was 57.8 months. A significantly longer survival was observed in patients with normal preoperative CRP level compared with those with CRP level exceeding 10mg/L (62.6 months vs. 34.3 months, P=0.011). In multivariate analysis, preoperative CRP level was found to be independent significant prognostic factors for survival.
  
  
  CONCLUSIONS
  Pulmonary resection of metastatic colorectal cancer might offer a chance to prolong survival including those patients with extrapulmonary metastasis. Preoperative serum CRP level was identified as prognosis-related factor for surgery.
authors.affiliation: Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China.
authors.forename: Cong
authors.initials: C
authors.lastname: Li
authors.affiliation: Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Xu
authors.affiliation: Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
authors.affiliation: Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China.
authors.forename: Cong
authors.initials: C
authors.lastname: Luo
authors.affiliation: Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China. Electronic address: yingjieer1@163.com.
authors.forename: Jieer
authors.initials: J
authors.lastname: Ying
authors.affiliation: Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China. Electronic address: liujs@zjcc.org.cn.
authors.forename: Jinshi
authors.initials: J
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D003110:Colonic Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D008297:Male; D059146:Metastasectomy / Q000401:mortality*; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy / Q000706:statistics & numerical data; D011379:Prognosis; D012004:Rectal Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000706:statistics & numerical data; D013908:Thoracotomy / Q000706:statistics & numerical data; D013997:Time Factors
chemical_list: D014408:Biomarkers, Tumor; D002097:C-Reactive Protein
keywords: CRP; Colorectal cancer; Prognosis; Pulmonary metastases; Resection