Abstract
Goals of work
C-reactive protein (CRP) has been investigated as a predictor of life expectancy in terminal cancer in one previous study. However, the other variables such as patient’s symptom or physical examination findings were not considered. The aim of this study is to prove serum CRP level as a predictor of survival time, considering patient’s symptoms, physical examination findings, and various serological variables in terminally ill cancer patients with a prospective cohort design.
Patients and methods
Forty-four terminally ill cancer patients were divided into two groups by serum CRP levels and followed up until death. We adjusted the influence of some clinical and laboratory variables on survival by use of Cox’s proportional hazard model. Using the stepwise variable selection method, we found the final model. For 19 patients, CRP levels at 2 weeks and a week before death were compared by Wilcoxon signed ranks test.
Main results
All 44 study subjects died during the study period, and the median survival time was 17 days. Survival time of the elevated CRP group (≥2.2 mg/dl) was found to be significantly shorter than the lower CRP group in univariate analysis (hazard rate = 3.221, P = 0.001). In multivariate analysis, elevated CRP level (≥2.2 mg/dl) was selected as one of the unfavorable indicators regarding survival. Dyspnea and hyperbilirubinemia were also found significant predictors of shorter life expectancy in the final model. Serum CRP levels were significantly increased between the first and the second week before death.
Conclusions
Our results showed that serum CRP level can be a useful indicator predictive of survival time of terminally ill cancer patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
den Daas N (1995) Estimating length of survival in end-stage cancer: a review of the literature. J Pain Symptom Manage 10:548–555
Geissbuhler P, Mermillod B, Rapin CH (2000) Elevated serum vitamin B12 levels associated with CRP as a predictive factor of mortality in palliative care cancer patients: a prospective study over five years. J Pain Symptom Manage 20:93–103
Burtis CA, Ashwood ER (1999) Tietz textbook of clinical chemistry, 3rd ed. W.B. Saunders company, Philadelphia, p 132
Falconer JS, Fearon KC, Ross JA et al (1995) Acute-phase protein response and survival duration of patients with pancreatic cancer. Cancer 75:2077–2082
Nozoe T, Matsumata T, Kitamura M, Sugimachi K (1998) Significance of preoperative elevation of serum C-reactive protein as an indicator for prognosis in colorectal cancer. Am J Surg 176:335–338
Nozoe T, Saeki H, Sugimachi K (2001) Significance of preoperative elevation of serum C-reactive protein as an indicator of prognosis in esophageal carcinoma. Am J Surg 182:197–201
Kroschinsky F, Weise M, Illmer T et al (2002) Outcome and prognostic features of intensive care unit treatment in patients with hematological malignancies. Intensive Care Med 28:1294–1300
Gabay C, Kushner I (1999) Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 340:448–454
Ridker PM, Buring JE, Cook NR, Rifai N (2003) C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events. Circulation 107:391–397
Di Napoli M, Papa F, Bocola V (2001) C-reactive protein in ischemic stroke: an independent prognostic factor. Stroke 32:917–924
Tamakoshi K, Yatsuya H, Kondo T et al (2003) The metabolic syndrome is associated with elevated circulating C-reactive protein in healthy reference range, a systemic low-grade inflammatory state. Int J Obes 27:443–449
Nelson KA, Walsh D (2002) The cancer anorexia-cachexia syndrome: a survey of the prognostic inflammatory and nutritional index (PINI) in advanced disease. J Pain Symptom Manage 24:424–428
Mahmoud FA, Rivera NI (2002) The role of C-reactive protein as a prognostic indicator in advanced cancer. Curr Oncol Rep 4:250–255
Miki C, Konishi N, Ojima E et al (2004) C-reactive protein as a prognostic variable that reflects uncontrolled up-regulation of the IL-1-IL-6 network system in colorectal carcinoma. Dig Dis Sci 49(6):970–976
McMillan DC, Wotherspoon HA, Fearon KC et al (1995) A prospective study of tumor recurrence and the acute-phase response after apparently curative colorectal cancer surgery. Am J Surg 170:319–322
Salvarani C, Cantini F, Niccoli L et al (2005) Acute-phase reactants and the risk of relapse/recurrence in polymyalgia rheumatica: a prospective followup study. Arthritis Rheum 53(1):33–38
Hashimoto K, Ikeda Y, Korenaga D et al (2005) The impact of preoperative serum C-reactive protein on the prognosis of patients with hepatocellular carcinoma. Cancer 103:1856–1864
Wigmore SJ, McMahon AJ, Sturgeon CM, Fearon KC (2001) Acute-phase protein response, survival and tumour recurrence in patients with colorectal cancer. Br J Surg 88:255–260
Kinoshita T, Ito H, Miki C (1999) Serum interleukin-6 level reflects the tumor proliferative activity in patients with colorectal carcinoma. Cancer 85:2526–2531
Nozoe T, Matsumata T, Sugimachi K (2000) Preoperative elevation of serum C-reactive protein is related to impaired immunity in patients with colorectal cancer. Am J Clin Oncol 23(3):263–266
Grobbelaar EJ, Owen S, Torrance AD, Wilson JA (2004) Nutritional challenges in head and neck cancer. Clin Otolaryngol 29:307–313
McMillan DC, Scott HR, Watson WS et al (1998) Longitudinal study of body cell mass depletion and the inflammatory response in cancer patients. Nutr Cancer 31(2):101–105
O’Gorman P, McMillan DC, McArdle CS (2000) Prognostic factors in advanced gastrointestinal cancer patients with weight loss. Nutr Cancer 37(1):36–40
Pearson TA, Mensah GA, Alexander RW et al (2003) Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 197:499–511
Legouffe E, Rodriguez C, Picot MC et al (1998) C-reactive protein serum level is a valuable and simple prognostic marker in non Hodgkin’s lymphoma. Leuk Lymphoma 31(3–4):351–357
Mantovani G, Maccio A, Madeddu C et al (2002) Quantitative evaluation of oxidative stress, chronic inflammatory indices and leptin in cancer patients: correlation with stage and performance status. Int J Cancer 98:84–91
Vigano A, Donaldson N, Higginson IJ et al (2004) Quality of life and survival prediction in terminal cancer patients. A multicenter study. Cancer 101:1090–1098
Pirovano M, Maltoni M, Nanni O et al (1999) A new palliative prognostic score: a first step for the staging of terminally ill cancer patients. J Pain Symptom Manage 17:231–239
Ripamonti C, Bruera E (1997) Dyspnea: pathophysiology and assessment. J Pain Symptom Manage 13:220–232
Hawkins WG, DeMatteo RP, Jarnagin WR et al (2004) Jaundice predicts advanced disease and early mortality in patients with gallbladder cancer. Ann Surg Oncol 11(3):310–315
Rosenthal MA, Gebski VJ, Kefford RF, Stuart-Harris RC (1993) Prediction of life-expectancy in hospice patients: identification of novel prognostic factors. Palliat Med 7(3):199–204
Ueno H, Okada S, Okusaka T et al (2000) Prognostic factors in patients with metastatic pancreatic adenocarcinoma receiving systemic chemotherapy. Oncology 59:296–301
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Suh, SY., Ahn, HY. A prospective study on C-reactive protein as a prognostic factor for survival time of terminally ill cancer patients. Support Care Cancer 15, 613–620 (2007). https://doi.org/10.1007/s00520-006-0208-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-006-0208-5