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Cancer Causes & Control

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01-11-2015 | Original paper

Association between preoperative C-reactive protein level and colorectal cancer survival: a meta-analysis

Authors: Hae Dong Woo, Kyeezu Kim, Jeongseon Kim

Published in: Cancer Causes & Control | Issue 11/2015

Abstract

Purpose

C-reactive protein (CRP) is widely known as a major nonspecific systemic inflammatory marker. A number of previous studies have suggested that elevated preoperative CRP is associated with poor prognosis in colorectal cancer. We aimed to explore the effects of preoperative CRP on colorectal cancer survival through a meta-analysis.

Methods

A total of 21 studies, including a total of 3934 colorectal cancer patients, were eligible. The multivariate-adjusted hazard ratios (HRs) and 95 % confidence intervals (CIs) of selected studies were used to assess the summary estimates of the association between preoperative CRP and colorectal cancer survival.

Results

The pooled HRs of elevated preoperative CRP for earlier stage patients were 2.04 (95 % CI 1.45–2.86) for OS, 4.37 (95 % CI 2.63–7.27) for CSS, and 1.88 (95 % CI 0.97–3.67) for DFS. The pooled HRs of a higher Glasgow Prognostic Score (GPS)/modified GPS (mGPS) for earlier stage patients were 2.20 (95 % CI 1.61–3.02) for OS and 1.80 (95 % CI 1.37–2.37) for CSS. The association between elevated preoperative CRP and poor survival was observed in patients with advanced cancer. Elevated CRP and GPS/mGPS were significantly associated with poor survival.

Conclusion

Preoperative CRP and its related markers, GPS and mGPS, were significantly associated with the survival of colorectal cancer surgery patients. The HRs of GPS and mGPS were highly homogeneous across studies for all survival types. Thus, GPS and mGPS may serve as stable predictors of the survival of colorectal cancer surgery patients.

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Pepys MB (2005) CRP or not CRP? That is the question. Arterioscler Thromb Vasc Biol 25:1091–1094CrossRefPubMed

Gabay C, Kushner I (1999) Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 340:448–454CrossRefPubMed

Gan W, Man S, Senthilselvan A, Sin D (2004) Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis. Thorax 59:574–580PubMedCentralCrossRefPubMed

Mantovani A, Allavena P, Sica A, Balkwill F (2008) Cancer-related inflammation. Nature 454:436–444CrossRefPubMed

Wu J, Cai Q, Li H, Cai H, Gao J, Yang G, Zheng W et al (2013) Circulating C-reactive protein and colorectal cancer risk: a report from the Shanghai Men’s Health Study. Carcinogenesis 34:2799–2803PubMedCentralCrossRefPubMed

Zhou B, Shu B, Yang J, Liu J, Xi T, Xing Y (2014) C-reactive protein, interleukin-6 and the risk of colorectal cancer: a meta-analysis. Cancer Causes Control 25:1397–1405CrossRefPubMed

Coussens LM, Werb Z (2002) Inflammation and cancer. Nature 420:860–867PubMedCentralCrossRefPubMed

Hussain SP, Harris CC (2007) Inflammation and cancer: an ancient link with novel potentials. Int J Cancer 121:2373–2380CrossRefPubMed

Roxburgh CS, Salmond JM, Horgan PG, Oien KA, McMillan DC (2009) The relationship between the local and systemic inflammatory responses and survival in patients undergoing curative surgery for colon and rectal cancers. J Gastrointest Surg 13:2011–2019CrossRefPubMed

10.

Leitch E, Chakrabarti M, Crozier J, McKee R, Anderson J, Horgan P, McMillan D (2007) Comparison of the prognostic value of selected markers of the systemic inflammatory response in patients with colorectal cancer. Br J Cancer 97:1266–1270PubMedCentralCrossRefPubMed

11.

Hamilton TD, Leugner D, Kopciuk K, Dixon E, Sutherland FR, Bathe OF (2014) Identification of prognostic inflammatory factors in colorectal liver metastases. BMC Cancer 14:542PubMedCentralCrossRefPubMed

12.

McMillan D, Canna K, McArdle C (2003) Systemic inflammatory response predicts survival following curative resection of colorectal cancer. Br J Surg 90:215–219CrossRefPubMed

13.

Crozier J, McKee R, McArdle C, Angerson W, Anderson J, Horgan P, McMillan D (2006) The presence of a systemic inflammatory response predicts poorer survival in patients receiving adjuvant 5-FU chemotherapy following potentially curative resection for colorectal cancer. Br J Cancer 94:1833–1836PubMedCentralCrossRefPubMed

14.

Wong V, Malik H, Hamady Z, Al-Mukhtar A, Gomez D, Prasad K, Toogood G et al (2007) C-reactive protein as a predictor of prognosis following curative resection for colorectal liver metastases. Br J Cancer 96:222–225PubMedCentralCrossRefPubMed

15.

Koike Y, Miki C, Okugawa Y, Yokoe T, Toiyama Y, Tanaka K, Inoue Y et al (2008) Preoperative C-reactive protein as a prognostic and therapeutic marker for colorectal cancer. J Surg Oncol 98:540–544CrossRefPubMed

16.

Nozoe T, Mori E, Takahashi I, Ezaki T (2008) Preoperative elevation of serum C-reactive protein as an independent prognostic indicator of colorectal carcinoma. Surg Today 38:597–602CrossRefPubMed

17.

Shiu Y-C, Lin J-K, Huang C-J, Jiang J-K, Wang L-W, Huang H-C, Yang S-H (2008) Is C-reactive protein a prognostic factor of colorectal cancer? Dis Colon Rectum 51:443–449CrossRefPubMed

18.

Ishizuka M, Kita J, Shimoda M, Rokkaku K, Kato M, Sawada T, Kubota K (2009) Systemic inflammatory response predicts postoperative outcome in patients with liver metastases from colorectal cancer. J Surg Oncol 100:38–42CrossRefPubMed

19.

Kobayashi T, Teruya M, Kishiki T, Endo D, Takenaka Y, Miki K, Kobayashi K et al (2010) Elevated C-reactive protein and hypoalbuminemia measured before resection of colorectal liver metastases predict postoperative survival. Dig Surg 27:285–290CrossRefPubMed

20.

Kwon KA, Kim SH, Oh SY, Lee S, Han J-Y, Kim KH, Goh RY et al (2010) Clinical significance of preoperative serum vascular endothelial growth factor, interleukin-6, and C-reactive protein level in colorectal cancer. BMC Cancer 10:203PubMedCentralCrossRefPubMed

21.

Toiyama Y, Miki C, Inoue Y, Tanaka K, Mohri Y, Kusunoki M (2011) Evaluation of an inflammation-based prognostic score for the identification of patients requiring postoperative adjuvant chemotherapy for stage II colorectal cancer. Exp Ther Med 2:95–101PubMedCentralPubMed

22.

Ishizuka M, Nagata H, Takagi K, Iwasaki Y, Kubota K (2012) Inflammation-based prognostic system predicts postoperative survival of colorectal cancer patients with a normal preoperative serum level of carcinoembryonic antigen. Ann Surg Oncol 19:3422–3431CrossRefPubMed

23.

Ishizuka M, Nagata H, Takagi K, Iwasaki Y, Kubota K (2013) Inflammation-based prognostic system predicts survival after surgery for stage IV colorectal cancer. Am J Surg 205:22–28CrossRefPubMed

24.

Kishiki T, Masaki T, Matsuoka H, Kobayashi T, Suzuki Y, Abe N, Mori T et al (2013) Modified Glasgow Prognostic Score in patients with incurable stage IV colorectal cancer. Am J Surg 206:234–240CrossRefPubMed

25.

Sugimoto K, Komiyama H, Kojima Y, Goto M, Tomiki Y, Sakamoto K (2013) Glasgow Prognostic Score as a prognostic factor in patients undergoing curative surgery for colorectal cancer. Dig Surg 29:503–509CrossRef

26.

Toiyama Y, Inoue Y, Saigusa S, Kawamura M, Kawamoto A, Okugawa Y, Hiro J et al (2013) C-reactive protein as predictor of recurrence in patients with rectal cancer undergoing chemoradiotherapy followed by surgery. Anticancer Res 33:5065–5074PubMed

27.

Toiyama Y, Fujikawa H, Koike Y, Saigusa S, Inoue Y, Tanaka K, Mohri Y et al (2013) Evaluation of preoperative C-reactive protein aids in predicting poor survival in patients with curative colorectal cancer with poor lymph node assessment. Oncol Lett 5:1881–1888PubMedCentralPubMed

28.

Kobayashi T, Kawakamil M, Hara Y, Shioiri S, Yasuno M, Teruya M, Kaminishi M (2014) Combined evaluation of the Glasgow Prognostic Score and carcinoembryonic antigen concentration prior to hepatectomy predicts postoperative outcomes in patients with liver metastasis from colorectal cancer. Hepatogastroenterology 61:1359–1362

29.

Nakagawa K, Tanaka K, Nojiri K, Kumamoto T, Takeda K, Ueda M, Endo I (2014) The modified Glasgow Prognostic Score as a predictor of survival after hepatectomy for colorectal liver metastases. Ann Surg Oncol 21:1711–1718PubMedCentralCrossRefPubMed

30.

Nozoe T, Matono R, Ijichi H, Ohga T, Ezaki T (2014) Glasgow Prognostic Score (GPS) can be a useful indicator to determine prognosis of patients with colorectal carcinoma. Int Surg 99:512–517PubMedCentralCrossRefPubMed

31.

Shibutani M, Maeda K, Nagahara H, Ohtani H, Sugano K, Ikeya T, Kimura K et al (2014) Elevated preoperative serum C-reactive protein levels are associated with poor survival in patients with colorectal cancer. Hepatogastroenterology 61:2236–2240PubMed

32.

Mori K, Toiyama Y, Saigusa S, Fujikawa H, Hiro J, Kobayashi M, Ohi M et al (2015) Systemic analysis of predictive biomarkers for recurrence in colorectal cancer patients treated with curative surgery. Dig Dis Sci 60:2477–2487. doi:10.1007/s10620-015-3648-2

33.

Park JH, Watt DG, Roxburgh CS, Horgan PG, McMillan DC (2015) Colorectal cancer, systemic inflammation, and outcome. Cancer 7:10

34.

Shibutani M, Maeda K, Nagahara H, Noda E, Ohtani H, Nishiguchi Y, Hirakawa K (2015) Prognostic significance of the preoperative serum C-reactive protein level in patients with stage IV colorectal cancer. Surg Today 45:315–321CrossRefPubMed

35.

Balkwill F, Mantovani A (2001) Inflammation and cancer: back to Virchow? Lancet 357:539–545CrossRefPubMed

36.

Babu SN, Chetal G, Kumar S (2012) Macrophage migration inhibitory factor: a potential marker for cancer diagnosis and therapy. Asian Pac J Cancer Prev 13:1737–1744CrossRefPubMed

37.

Elahi MM, McMillan DC, McArdle CS, Angerson WJ, Sattar N (2004) Score based on hypoalbuminemia and elevated C-reactive protein predicts survival in patients with advanced gastrointestinal cancer. Nutr Cancer 48:171–173CrossRefPubMed

38.

Hashimoto K, Ikeda Y, Korenaga D, Tanoue K, Hamatake M, Kawasaki K, Yamaoka T et al (2005) The impact of preoperative serum C-reactive protein on the prognosis of patients with hepatocellular carcinoma. Cancer 103:1856–1864CrossRefPubMed

39.

Hefler LA, Concin N, Hofstetter G, Marth C, Mustea A, Sehouli J, Zeillinger R et al (2008) Serum C-reactive protein as independent prognostic variable in patients with ovarian cancer. Clin Cancer Res 14:710–714CrossRefPubMed

40.

Han Y, Mao F, Wu Y, Fu X, Zhu X, Zhou S, Zhang W et al (2010) Prognostic role of C-reactive protein in breast cancer: a systematic review and meta-analysis. Int J Biol Marker 26:209–215

41.

Wu Y, Fu X, Zhu X, He X, Zou C, Han Y, Xu M et al (2011) Prognostic role of systemic inflammatory response in renal cell carcinoma: a systematic review and meta-analysis. J Cancer Res Clin Oncol 137:887–896CrossRefPubMed

42.

Liu Z-Q, Chu L, Fang J-M, Zhang X, Zhao H-X, Chen Y-J, Xu Q (2014) Prognostic role of C-reactive protein in prostate cancer: a systematic review and meta-analysis. Asian J Androl 16:467PubMedCentralCrossRefPubMed

43.

Corpet DE, Taché S (2002) Most effective colon cancer chemopreventive agents in rats: a systematic review of aberrant crypt foci and tumor data, ranked by potency. Nutr Cancer 43:1–21PubMedCentralCrossRefPubMed

44.

Itzkowitz SH, Yio X (2004) Inflammation and cancer IV. Colorectal cancer in inflammatory bowel disease: the role of inflammation. Am J Physiol Gastrointest Liver Physiol 287:G7–G17CrossRefPubMed

45.

Moore M, Chua W, Charles K, Clarke S (2010) Inflammation and cancer: causes and consequences. Clin Pharmacol Ther 87:504–508CrossRefPubMed

46.

Sgambato A, Cittadini A (2010) Inflammation and cancer: a multifaceted link. Eur Rev Med Pharmacol Sci 14:263–268PubMed

47.

Sandler RS, Halabi S, Baron JA, Budinger S, Paskett E, Keresztes R, Petrelli N et al (2003) A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. N Engl J Med 348:883–890CrossRefPubMed

48.

Benamouzig R, Deyra J, Martin A, Girard B, Jullian E, Piednoir B, Couturier D et al (2003) Daily soluble aspirin and prevention of colorectal adenoma recurrence: one-year results of the APACC trial. Gastroenterology 125:328–336CrossRefPubMed

49.

Allin KH, Nordestgaard BG (2011) Elevated C-reactive protein in the diagnosis, prognosis, and cause of cancer. Crit Rev Clin Lab Sci 48:155–170CrossRefPubMed

50.

Allin KH, Nordestgaard BG, Flyger H, Bojesen SE (2011) Elevated pre-treatment levels of plasma C-reactive protein are associated with poor prognosis after breast cancer: a cohort study. Breast Cancer Res 13:R55PubMedCentralCrossRefPubMed

51.

Longo WE, Virgo KS, Johnson FE, Oprian CA, Vernava AM, Wade TP, Phelan MA et al (2000) Risk factors for morbidity and mortality after colectomy for colon cancer. Dis Colon Rectum 43:83–91CrossRefPubMed

52.

Al-Shaiba R, McMillan D, Angerson W, Leen E, McArdle C, Horgan P (2004) The relationship between hypoalbuminaemia, tumour volume and the systemic inflammatory response in patients with colorectal liver metastases. Br J Cancer 91:205–207PubMedCentralPubMed

53.

McMillan DC, Crozier JE, Canna K, Angerson WJ, McArdle CS (2007) Evaluation of an inflammation-based prognostic score (GPS) in patients undergoing resection for colon and rectal cancer. Int J Colorectal Dis 22:881–886CrossRefPubMed

Title: Association between preoperative C-reactive protein level and colorectal cancer survival: a meta-analysis
Authors: Hae Dong Woo
Kyeezu Kim
Jeongseon Kim
Publication date: 01-11-2015
Publisher: Springer International Publishing
Published in: Cancer Causes & Control / Issue 11/2015
Print ISSN: 0957-5243
Electronic ISSN: 1573-7225
DOI: https://doi.org/10.1007/s10552-015-0663-8

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Abstract

Purpose

Methods

Results

Conclusion

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