Skip to main content
Top
Published in: Surgery Today 11/2018

01-11-2018 | Original Article

Prognostic value of the combination of pre- and postoperative C-reactive protein in colorectal cancer patients

Published in: Surgery Today | Issue 11/2018

Login to get access

Abstract

Purpose

Inflammation is closely related to cancer development and progression. This retrospective study investigated the prognostic value of the combination of pre- and postoperative C-reactive protein (CRP) levels in patients with colorectal cancer (CRC).

Methods

The subjects of this study were 406 patients who underwent surgery for CRC.

Results

Based on receiver-operating characteristic analysis, patients were divided into the following groups: those with a preoperative CRP of ≥ 0.5 mg/dL (pre-CRPHigh), those with a preoperative CRP of < 0.5 mg/dL (pre-CRPLow), those with a postoperative CRP of ≥ 17.0 mg/dL (post-CRPHigh), and those with a postoperative CRP of < 17.0 mg/dL (post-CRPLow). They were then allocated to one of the following three groups: Group A, comprised of those in the pre-CRPHigh and post-CRPHigh groups; Group B, comprised of those in either the pre-CRPHigh and post-CRPLow or pre-CRPLow and post-CRPHigh groups; and Group C, comprised of those in the pre-CRPLow and post-CRPLow groups. The disease-specific 5-year survival rates were 53.8%, 72.8%, and 87.2% in Groups A, B, and C, respectively, and these differences were significant. Finally, multivariate analysis revealed that the combination of pre- and postoperative CRP levels was an independent prognostic indicator.

Conclusions

The combination of pre- and postoperative CRP was predictive of the prognosis of CRC patients.
Literature
1.
go back to reference Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108.CrossRefPubMed Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108.CrossRefPubMed
2.
go back to reference Park YJ, Park KJ, Park JG, Lee KU, Choe KJ, Kim JP. Prognostic factors in 2230 Korean colorectal cancer patients: analysis of consecutively operated cases. World J Surg. 1999;23:721–6.CrossRefPubMed Park YJ, Park KJ, Park JG, Lee KU, Choe KJ, Kim JP. Prognostic factors in 2230 Korean colorectal cancer patients: analysis of consecutively operated cases. World J Surg. 1999;23:721–6.CrossRefPubMed
3.
go back to reference Stiksma J, Grootendorst DC, van der Linden PW. CA 19-9 as a marker in addition to CEA to monitor colorectal cancer. Clin Colorectal Cancer. 2014;13:239–44.CrossRefPubMed Stiksma J, Grootendorst DC, van der Linden PW. CA 19-9 as a marker in addition to CEA to monitor colorectal cancer. Clin Colorectal Cancer. 2014;13:239–44.CrossRefPubMed
5.
go back to reference Kim EY, Lee JW, Yoo HM, Park CH, Song KY. The platelet-to-lymphocyte ratio versus neutrophil-to-lymphocyte ratio: which is better as a prognostic factor in gastric cancer? Ann Surg Oncol. 2015;22:4363–70.CrossRefPubMed Kim EY, Lee JW, Yoo HM, Park CH, Song KY. The platelet-to-lymphocyte ratio versus neutrophil-to-lymphocyte ratio: which is better as a prognostic factor in gastric cancer? Ann Surg Oncol. 2015;22:4363–70.CrossRefPubMed
6.
go back to reference Absenger G, Szkandera J, Stotz M, Postlmayr U, Pichler M, Ress AL, et al. Preoperative neutrophil-to-lymphocyte ratio predicts clinical outcome in patients with stage II and III colon cancer. Anticancer Res. 2013;33:4591–4.PubMed Absenger G, Szkandera J, Stotz M, Postlmayr U, Pichler M, Ress AL, et al. Preoperative neutrophil-to-lymphocyte ratio predicts clinical outcome in patients with stage II and III colon cancer. Anticancer Res. 2013;33:4591–4.PubMed
7.
go back to reference Stotz M, Gerger A, Eisner F, Szkandera J, Loibner H, Ress AL, et al. Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer. Br J Cancer. 2013;109:416–21.CrossRefPubMedPubMedCentral Stotz M, Gerger A, Eisner F, Szkandera J, Loibner H, Ress AL, et al. Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer. Br J Cancer. 2013;109:416–21.CrossRefPubMedPubMedCentral
8.
go back to reference Kumar R, Geuna E, Michalarea V, Guardascione M, Naumann U, Lorente D, et al. The neutrophil-lymphocyte ratio and its utilisation for the management of cancer patients in early clinical trials. Br J Cancer. 2015;112:1157–65.CrossRefPubMedPubMedCentral Kumar R, Geuna E, Michalarea V, Guardascione M, Naumann U, Lorente D, et al. The neutrophil-lymphocyte ratio and its utilisation for the management of cancer patients in early clinical trials. Br J Cancer. 2015;112:1157–65.CrossRefPubMedPubMedCentral
9.
go back to reference Yodying H, Matsuda A, Miyashita M, Matsumoto S, Sakurazawa N, Yamada M, et al. Prognostic significance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in oncologic outcomes of esophageal cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2016;23:646–54.CrossRefPubMed Yodying H, Matsuda A, Miyashita M, Matsumoto S, Sakurazawa N, Yamada M, et al. Prognostic significance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in oncologic outcomes of esophageal cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2016;23:646–54.CrossRefPubMed
10.
go back to reference Spolverato G, Maqsood H, Kim Y, Margonis G, Luo T, Ejaz A, et al. Neutrophil-lymphocyte and platelet-lymphocyte ratio in patients after resection for hepato-pancreatico-biliary malignancies. J Surg Oncol. 2015;111:868–74.CrossRefPubMed Spolverato G, Maqsood H, Kim Y, Margonis G, Luo T, Ejaz A, et al. Neutrophil-lymphocyte and platelet-lymphocyte ratio in patients after resection for hepato-pancreatico-biliary malignancies. J Surg Oncol. 2015;111:868–74.CrossRefPubMed
11.
go back to reference Petrelli F, Barni S, Coinu A, Bertocchi P, Borgonovo K, Cabiddu M, et al. The modified Glasgow Prognostic Score and survival in colorectal cancer: a pooled analysis of the literature. Rev Recent Clin Trials 2015;10:135–41.CrossRefPubMed Petrelli F, Barni S, Coinu A, Bertocchi P, Borgonovo K, Cabiddu M, et al. The modified Glasgow Prognostic Score and survival in colorectal cancer: a pooled analysis of the literature. Rev Recent Clin Trials 2015;10:135–41.CrossRefPubMed
12.
go back to reference Shibutani M, Maeda K, Nagahara H, Iseki Y, Ikeya T, Hirakawa K. Prognostic significance of the preoperative ratio of C-reactive protein to albumin in patients with colorectal cancer. Anticancer Res. 2016;36:995–1001.PubMed Shibutani M, Maeda K, Nagahara H, Iseki Y, Ikeya T, Hirakawa K. Prognostic significance of the preoperative ratio of C-reactive protein to albumin in patients with colorectal cancer. Anticancer Res. 2016;36:995–1001.PubMed
13.
go back to reference Nielsen HJ, Christensen IJ, Sorensen S, Moesgaard F, Brunner N. Preoperative plasma plasminogen activator inhibitor type-1 and serum C-reactive protein levels in patients with colorectal cancer. The RANX05 Colorectal Cancer Study Group. Ann Surg Oncol. 2000;7:617–23.CrossRefPubMed Nielsen HJ, Christensen IJ, Sorensen S, Moesgaard F, Brunner N. Preoperative plasma plasminogen activator inhibitor type-1 and serum C-reactive protein levels in patients with colorectal cancer. The RANX05 Colorectal Cancer Study Group. Ann Surg Oncol. 2000;7:617–23.CrossRefPubMed
14.
go back to reference Gockel I, Dirksen K, Messow CM, Junginger T. Significance of preoperative C-reactive protein as a parameter of the perioperative course and long-term prognosis in squamous cell carcinoma and adenocarcinoma of the oesophagus. World J Gastroenterol. 2006;12:3746–50.CrossRefPubMedPubMedCentral Gockel I, Dirksen K, Messow CM, Junginger T. Significance of preoperative C-reactive protein as a parameter of the perioperative course and long-term prognosis in squamous cell carcinoma and adenocarcinoma of the oesophagus. World J Gastroenterol. 2006;12:3746–50.CrossRefPubMedPubMedCentral
15.
go back to reference Polterauer S, Grimm C, Tempfer C, Sliutz G, Speiser P, Reinthaller A, et al. C-reactive protein is a prognostic parameter in patients with cervical cancer. Gynecol Oncol. 2007;107:114–7.CrossRefPubMed Polterauer S, Grimm C, Tempfer C, Sliutz G, Speiser P, Reinthaller A, et al. C-reactive protein is a prognostic parameter in patients with cervical cancer. Gynecol Oncol. 2007;107:114–7.CrossRefPubMed
16.
go back to reference Hu Q, Gou Y, Sun C, Ding W, Xu K, Gu B, et al. The prognostic value of C-reactive protein in renal cell carcinoma: a systematic review and meta-analysis. Urol Oncol. 2014;32:50.e1-8.CrossRefPubMed Hu Q, Gou Y, Sun C, Ding W, Xu K, Gu B, et al. The prognostic value of C-reactive protein in renal cell carcinoma: a systematic review and meta-analysis. Urol Oncol. 2014;32:50.e1-8.CrossRefPubMed
17.
go back to reference Saito T, Kurokawa Y, Miyazaki Y, Makino T, Takahashi T, Yamasaki M, et al. Which is a more reliable indicator of survival after gastric cancer surgery: postoperative complication occurrence or C-reactive protein elevation? J Surg Oncol. 2015;112:894–9.CrossRefPubMed Saito T, Kurokawa Y, Miyazaki Y, Makino T, Takahashi T, Yamasaki M, et al. Which is a more reliable indicator of survival after gastric cancer surgery: postoperative complication occurrence or C-reactive protein elevation? J Surg Oncol. 2015;112:894–9.CrossRefPubMed
18.
go back to reference Ibuki Y, Hamai Y, Hihara J, Emi M, Taomoto J, Furukawa T, et al. Role of postoperative C-reactive protein levels in predicting prognosis after surgical treatment of esophageal cancer. World J Surg. 2017;41:1558–65.CrossRefPubMed Ibuki Y, Hamai Y, Hihara J, Emi M, Taomoto J, Furukawa T, et al. Role of postoperative C-reactive protein levels in predicting prognosis after surgical treatment of esophageal cancer. World J Surg. 2017;41:1558–65.CrossRefPubMed
19.
go back to reference Japanese Society for Cancer of the Colon and Rectum. Japanese Classification of Colorectal Carcinoma. Tokyo: Kanehara. 2013. Japanese Society for Cancer of the Colon and Rectum. Japanese Classification of Colorectal Carcinoma. Tokyo: Kanehara. 2013.
21.
go back to reference Thomsen M, Kersten C, Sorbye H, Skovlund E, Glimelius B, Pfeiffer P, et al. Interleukin-6 and C-reactive protein as prognostic biomarkers in metastatic colorectal cancer. Oncotarget. 2016;7:75013–22.CrossRefPubMedPubMedCentral Thomsen M, Kersten C, Sorbye H, Skovlund E, Glimelius B, Pfeiffer P, et al. Interleukin-6 and C-reactive protein as prognostic biomarkers in metastatic colorectal cancer. Oncotarget. 2016;7:75013–22.CrossRefPubMedPubMedCentral
22.
go back to reference Hara M, Nagasaki T, Shiga K, Takahashi H, Takeyama H. High serum levels of interleukin-6 in patients with advanced or metastatic colorectal cancer: the effect on the outcome and the response to chemotherapy plus bevacizumab. Surg Today. 2017;47:483–9.CrossRefPubMed Hara M, Nagasaki T, Shiga K, Takahashi H, Takeyama H. High serum levels of interleukin-6 in patients with advanced or metastatic colorectal cancer: the effect on the outcome and the response to chemotherapy plus bevacizumab. Surg Today. 2017;47:483–9.CrossRefPubMed
23.
go back to reference Morris-Stiff G, Gomez D, Prasad KR. C-reactive protein in liver cancer surgery. Eur J Surg Oncol. 2008;34:727–9.CrossRefPubMed Morris-Stiff G, Gomez D, Prasad KR. C-reactive protein in liver cancer surgery. Eur J Surg Oncol. 2008;34:727–9.CrossRefPubMed
24.
go back to reference Li YY, Hsieh LL, Tang RP, Liao SK, Yeh KY. Interleukin-6 (IL-6) released by macrophages induces IL-6 secretion in the human colon cancer HT-29 cell line. Human Immunol. 2009;70:151–8.CrossRef Li YY, Hsieh LL, Tang RP, Liao SK, Yeh KY. Interleukin-6 (IL-6) released by macrophages induces IL-6 secretion in the human colon cancer HT-29 cell line. Human Immunol. 2009;70:151–8.CrossRef
25.
go back to reference Chung YC, Chaen YL, Hsu CP. Clinical significance of tissue expression of interleukin-6 in colorectal carcinoma. Anticancer Res. 2006;26:3905–11.PubMed Chung YC, Chaen YL, Hsu CP. Clinical significance of tissue expression of interleukin-6 in colorectal carcinoma. Anticancer Res. 2006;26:3905–11.PubMed
26.
go back to reference Ishizuka M, Nagata H, Takagi K, Iwasaki Y, Kubota K. Inflammation-based prognostic system predicts postoperative survival of colorectal cancer patients with a normal preoperative serum level of carcinoembryonic antigen. Ann Surg Oncol. 2012;19:3422–31.CrossRefPubMed Ishizuka M, Nagata H, Takagi K, Iwasaki Y, Kubota K. Inflammation-based prognostic system predicts postoperative survival of colorectal cancer patients with a normal preoperative serum level of carcinoembryonic antigen. Ann Surg Oncol. 2012;19:3422–31.CrossRefPubMed
27.
go back to reference Johnson TV, Abbasi A, Owen-Smith A, Young AN, Kucuk O, Harris WB, et al. Postoperative better than preoperative C-reactive protein at predicting outcome after potentially curative nephrectomy for renal cell carcinoma. Urology. 2010;76:766.e1–5.CrossRef Johnson TV, Abbasi A, Owen-Smith A, Young AN, Kucuk O, Harris WB, et al. Postoperative better than preoperative C-reactive protein at predicting outcome after potentially curative nephrectomy for renal cell carcinoma. Urology. 2010;76:766.e1–5.CrossRef
28.
go back to reference Artinyan A, Orcutt ST, Anaya DA, Richardson P, Chen GJ, Berger DH. Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg. 2015;261:497–505.CrossRefPubMed Artinyan A, Orcutt ST, Anaya DA, Richardson P, Chen GJ, Berger DH. Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg. 2015;261:497–505.CrossRefPubMed
29.
go back to reference Goto S, Hasegawa S, Hida K, Uozumi R, Kanemitsu Y, Watanabe T, et al. Multicenter analysis of impact of anastomotic leakage on long-term oncologic outcomes after curative resection of colon cancer. Surgery. 2017. Goto S, Hasegawa S, Hida K, Uozumi R, Kanemitsu Y, Watanabe T, et al. Multicenter analysis of impact of anastomotic leakage on long-term oncologic outcomes after curative resection of colon cancer. Surgery. 2017.
30.
go back to reference Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454:436–44.CrossRefPubMed Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454:436–44.CrossRefPubMed
31.
go back to reference McMillan DC. Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care. 2009;12:223–6.CrossRefPubMed McMillan DC. Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care. 2009;12:223–6.CrossRefPubMed
32.
go back to reference Horn F, Henze C, Heidrich K. Interleukin-6 signal transduction and lymphocyte function. Immunobiology. 2000;202:151–67.CrossRefPubMed Horn F, Henze C, Heidrich K. Interleukin-6 signal transduction and lymphocyte function. Immunobiology. 2000;202:151–67.CrossRefPubMed
33.
go back to reference Menetrier-Caux C, Montmain G, Dieu MC, Bain C, Favrot MC, Caux C, et al. Inhibition of the differentiation of dendritic cells from CD34(+) progenitors by tumor cells: role of interleukin-6 and macrophage colony-stimulating factor. Blood. 1998;92:4778–91.PubMed Menetrier-Caux C, Montmain G, Dieu MC, Bain C, Favrot MC, Caux C, et al. Inhibition of the differentiation of dendritic cells from CD34(+) progenitors by tumor cells: role of interleukin-6 and macrophage colony-stimulating factor. Blood. 1998;92:4778–91.PubMed
34.
go back to reference Schreiber RD, Old LJ, Smyth MJ. Cancer immunoediting: integrating immunity’s roles in cancer suppression and promotion. Science. 2011;331:1565–70.CrossRefPubMed Schreiber RD, Old LJ, Smyth MJ. Cancer immunoediting: integrating immunity’s roles in cancer suppression and promotion. Science. 2011;331:1565–70.CrossRefPubMed
35.
go back to reference Jawed I, Wilkerson J, Prasad V, Duffy AG, Fojo T. Colorectal cancer survival gains and novel treatment regimens: a systematic review and analysis. JAMA Oncol. 2015;1:787–95.CrossRefPubMed Jawed I, Wilkerson J, Prasad V, Duffy AG, Fojo T. Colorectal cancer survival gains and novel treatment regimens: a systematic review and analysis. JAMA Oncol. 2015;1:787–95.CrossRefPubMed
36.
go back to reference Fora A, Patta A, Attwood K, Wilding G, Fakih M. Intensive radiographic and biomarker surveillance in stage II and III colorectal cancer. Oncology. 2012;82:41–7.CrossRefPubMed Fora A, Patta A, Attwood K, Wilding G, Fakih M. Intensive radiographic and biomarker surveillance in stage II and III colorectal cancer. Oncology. 2012;82:41–7.CrossRefPubMed
37.
go back to reference Pita-Fernandez S, Alhayek-Ai M, Gonzalez-Martin C, Lopez-Calvino B, Seoane-Pillado T, Pertega-Diaz S. Intensive follow-up strategies improve outcomes in nonmetastatic colorectal cancer patients after curative surgery: a systematic review and meta-analysis. Ann Oncol. 2015;26:644–56.CrossRefPubMed Pita-Fernandez S, Alhayek-Ai M, Gonzalez-Martin C, Lopez-Calvino B, Seoane-Pillado T, Pertega-Diaz S. Intensive follow-up strategies improve outcomes in nonmetastatic colorectal cancer patients after curative surgery: a systematic review and meta-analysis. Ann Oncol. 2015;26:644–56.CrossRefPubMed
Metadata
Title
Prognostic value of the combination of pre- and postoperative C-reactive protein in colorectal cancer patients
Publication date
01-11-2018
Published in
Surgery Today / Issue 11/2018
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-018-1689-9

Other articles of this Issue 11/2018

Surgery Today 11/2018 Go to the issue