Abstract
Purpose
Only a limited number of patients with peritoneal carcinomatosis (PC) of colorectal origin benefit from palliative chemotherapy. Identification of prognostic factors may aid in patient selection. The plasma concentration of C-reactive protein (CRP) is increasingly recognized as prognostic factor in a variety of malignancies. However, its value in peritoneal PC of colorectal origin is currently unknown. The aim of the present study was to investigate the association of plasma CRP concentrations with survival in patients suffering from PC of colorectal origin who receive palliative chemotherapy.
Methods
Fifty patients with colorectal PC were identified from the Eindhoven Cancer Registry. Relevant data were retrieved from their clinical records. The most discriminatory CRP concentration was identified and patients were stratified accordingly, resulting in a group with low and a group with high CRP concentrations. Further comparisons were made between these groups.
Results
A CRP concentration <35 mg/L was associated with a better prognosis (median survival 22.4 months) than a CRP concentration ≥35 mg/L (7.9 months) (p = 0.0002). CRP concentrations were inversely related to albumin concentrations which could predict survival at a cut-off value of 35 g/L (median survival 7.2 vs. 12.9 months, p = 0.01). High CRP concentrations were related to a decreased resectability rate of the primary tumor.
Conclusion
Elevated CRP plasma concentrations are associated with decreased survival in patients with colorectal PC. This reflects the importance of inflammation in cancer survival. Further research is warranted to assess the clinical applicability of the current findings.
Similar content being viewed by others
References
Chu DZ, Lang NP, Thompson C, Osteen PK, Westbrook KC (1989) Peritoneal carcinomatosis in nongynecologic malignancy. A prospective study of prognostic factors. Cancer 63:364–367
Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H (2008) 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol 15:2426–2432
Koppe MJ, Boerman OC, Oyen WJ, Bleichrodt RP (2006) Peritoneal carcinomatosis of colorectal origin: incidence and current treatment strategies. Ann Surg 243:212–222
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (2010) AJCC cancer staging manual. Springer, New York
Ueno H, Mochizuki H, Hashiguchi Y, Ishiguro M, Kajiwara Y, Sato T, Shimazaki H, Hase K, Talbot IC (2008) Histological grading of colorectal cancer: a simple and objective method. Ann Surg 247:811–818
Takagawa R, Fujii S, Ohta M, Nagano Y, Kunisaki C, Yamagishi S, Osada S, Ichikawa Y, Shimada H (2008) Preoperative serum carcinoembryonic antigen level as a predictive factor of recurrence after curative resection of colorectal cancer. Ann Surg Oncol 15:3433–3439
Ishizuka M, Nagata H, Takagi K, Kubota K (2009) Influence of inflammation-based prognostic score on mortality of patients undergoing chemotherapy for far advanced or recurrent unresectable colorectal cancer. Ann Surg 250:268–272
Zacharakis M, Xynos ID, Lazaris A, Smaro T, Kosmas C, Dokou A, Felekouras E, Antoniou E, Polyzos A, Sarantonis J, Syrios J, Zografos G et al (2010) Predictors of survival in stage IV metastatic colorectal cancer. Anticancer Res 30:653–660
Koike Y, Miki C, Okugawa Y, Yokoe T, Toiyama Y, Tanaka K, Inoue Y, Kusunoki M (2008) Preoperative C-reactive protein as a prognostic and therapeutic marker for colorectal cancer. J Surg Oncol 98:540–544
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 38:597–602
Crozier JE, McKee RF, McArdle CS, Angerson WJ, Anderson JH, Horgan PG, McMillan DC (2007) Preoperative but not postoperative systemic inflammatory response correlates with survival in colorectal cancer. Br J Surg 94:1028–1032
Shiu YC, Lin JK, Huang CJ, Jiang JK, Wang LW, Huang HC, Yang SH (2008) Is C-reactive protein a prognostic factor of colorectal cancer? Dis Colon Rectum 51:443–449
Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ (2003) Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer 89:1028–1030
Gagnon B, Abrahamowicz M, Xiao Y, Beauchamp ME, MacDonald N, Kasymjanova G, Kreisman H, Small D (2010) Flexible modeling improves assessment of prognostic value of C-reactive protein in advanced non-small cell lung cancer. Br J Canc 102:1113–1122
Pine JK, Fusai KG, Young R, Sharma D, Davidson BR, Menon KV, Rahman SH (2009) Serum C-reactive protein concentration and the prognosis of ductal adenocarcinoma of the head of pancreas. Eur J Surg Oncol 35:605–610
Khandavilli SD, Ceallaigh PO, Lloyd CJ, Whitaker R (2009) Serum C-reactive protein as a prognostic indicator in patients with oral squamous cell carcinoma. Oral Oncol 45:912–914
Pierce BL, Ballard-Barbash R, Bernstein L, Baumgartner RN, Neuhouser ML, Wener MH, Baumgartner KB, Gilliland FD, Sorensen BE, McTiernan A, Ulrich CM (2009) Elevated biomarkers of inflammation are associated with reduced survival among breast cancer patients. J Clin Oncol 27:3437–3444
Vainas T, Stassen FR, de Graaf R, Twiss EL, Herngreen SB, Welten RJ, van den Akker LH, van Dieijen-Visser MP, Bruggeman CA, Kitslaar PJ (2005) C-reactive protein in peripheral arterial disease: relation to severity of the disease and to future cardiovascular events. J Vasc Surg 42:243–251
van Dielen FM, Buurman WA, Hadfoune M, Nijhuis J, Greve JW (2004) Macrophage inhibitory factor, plasminogen activator inhibitor-1, other acute phase proteins, and inflammatory mediators normalize as a result of weight loss in morbidly obese subjects treated with gastric restrictive surgery. J Clin Endocrinol Metab 89:4062–4068
Moore MM, Chua W, Charles KA, Clarke SJ (2010) Inflammation and cancer: causes and consequences. Clin Pharmacol Ther 87:504–508
Moses AG, Maingay J, Sangster K, Fearon KC, Ross JA (2009) Pro-inflammatory cytokine release by peripheral blood mononuclear cells from patients with advanced pancreatic cancer: relationship to acute phase response and survival. Oncol Rep 21:1091–1095
Wigmore SJ, Redhead DN, Yan XJ, Casey J, Madhavan K, Dejong CH, Currie EJ, Garden OJ (2001) Virtual hepatic resection using three-dimensional reconstruction of helical computed tomography angioportograms. Ann Surg 233:221–226
van de Poll MC, Wigmore SJ, Redhead DN, Beets-Tan RG, Garden OJ, Greve JW, Soeters PB, Deutz NE, Fearon KC, Dejong CH (2007) Effect of major liver resection on hepatic ureagenesis in humans. Am J Physiol 293:G956–G962
Koukourakis MI, Kambouromiti G, Pitsiava D, Tsousou P, Tsiarkatsi M, Kartalis G (2009) Serum C-reactive protein (CRP) levels in cancer patients are linked with tumor burden and are reduced by anti-hypertensive medication. Inflammation 32:169–175
Crozier JE, McMillan DC, McArdle CS, Angerson WJ, Anderson JH, Horgan PG, McKee RF (2007) Tumor size is associated with the systemic inflammatory response but not survival in patients with primary operable colorectal cancer. J Gastroenterol Hepatol 22:2288–2291
Damjanov N, Weiss J, Haller DG (2009) Resection of the primary colorectal cancer is not necessary in nonobstructed patients with metastatic disease. Oncologist 14:963–969
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
ESM 1
(JPEG 38 kb)
Rights and permissions
About this article
Cite this article
van de Poll, M.C.G., Klaver, Y.L.B., Lemmens, V.E.P.P. et al. C-reactive protein concentration is associated with prognosis in patients suffering from peritoneal carcinomatosis of colorectal origin. Int J Colorectal Dis 26, 1067–1073 (2011). https://doi.org/10.1007/s00384-011-1187-7
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-011-1187-7