Pre-Treatment C-Reactive Protein Predicts Survival in Small Cell Lung Cancer Patients

Anne Marie Stensvold,Anne Winther-Larsen,Ninna Aggerholm-Pedersen,Birgitte Sandfeld-Paulsen

doi:10.3390/onco1020010

Anne Marie Stensvold, Anne Winther-Larsen + Show 2 more

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https://doi.org/10.3390/onco1020010

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Abstract

Improved prognostication of small cell lung cancer (SCLC) patients could strengthen the treatment strategy and, thereby, potentially improve the overall survival (OS) of these patients. C-reactive protein (CRP) has been proposed as a prognostic indicator of inferior survival, although so far, only based on data from smaller studies. Data on SCLC patients diagnosed from January 2009 to June 2018 were extracted from the Danish Lung Cancer Registry and the clinical laboratory information system. CRP measurements were divided at the clinical cut-off value of 8 mg/L or 75 nmol/L) and stratified into quartiles. Cox proportional hazards model assessed the prognostic value of the CRP level. C-statistics further evaluated the biomarker’s prognostic value. In total, 923 patients were included. A pre-treatment CRP level above the clinical cut-off significantly correlated to inferior OS (adjusted hazard ratio (HR) = 1.25 (95% confidence interval (CI): 1.08–1.46). When divided into quartiles, a level-dependent correlation was observed with only the highest quartiles significantly associated with OS (3rd quartile: adjusted HR = 1.26 (95% CI: 1.03–1.55) 4th quartile: adjusted HR = 1.44 (95% CI: 1.17–1.77)). Adding CRP level to already well-established prognostic factors improved the prognostication of SCLC patients. In conclusion, high pre-treatment CRP level is an independent prognostic factor in SCLC patients.

Highlights

In this register-based study of 923 small cell lung cancer (SCLC) patients, we investigated the prognostic value of an elevated pre-treatment Creactive protein (CRP) level and found that a CRP level above the clinical cut-off value was correlated with an inferior survival, independent of other well-known factors such as stage and performance status (PS)
We observed that adding CRP level divided in quartiles to the well-known prognostic factors increased the prognostication of survival in this patient group
Even though PS and stage is associated with overall survival of cancer patients, this does not diminish our result of CRP as a prognostic factor as we found the association independent of PS and stage

Summary

Introduction

Lung cancer is the leading cause of cancer-related death worldwide, with 1.76 million deaths in 2018 [1]. Small cell lung cancer (SCLC) is the most aggressive type of lung cancer associated with a high mortality and accounts for 15% of patients with lung cancer. To improve the overall survival (OS) of this patient subgroup, an optimised stratification of patients’ mortality risk is needed to prepare a more personalised treatment for each patient. Stage and performance status (PS) are the two most validated prognostic factors to consider. Patients’ prognosis can vary considerably within the same

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