Abstract
ObjectivesThis study tested the relationship between preoperative serum C-reactive protein (CRP) levels and cancer-specific prognosis in patients with esophageal squamous cell carcinoma who have undergone curative resection.MethodsWe conducted a retrospective study on 961 patients with esophageal squamous cell cancer who underwent curative esophagectomy from 2006 to 2012 at the Sun Yat-sen University Cancer Center. Preoperative serum CRP levels were determined, and a cutoff value of 5.0 mg/mL was established. Propensity score matching (PSM) was performed to reduce the selection bias between patients with low CRP (≤ 5.0 mg/mL) and those with high CRP (> 5.0 mg/mL) levels based on age, tumor-lymph node-metastasis (TNM) stage, and tumor grade. The prognostic value of preoperative CRP levels was determined using life table, Kaplan–Meier, and Cox proportional hazards analyzes.ResultsIn the unmatched cohort, the 3-year and 5-year survival rates were 57 and 53%, respectively, in patients with high preoperative CRP levels (> 5.0 mg/mL) and 68 and 56%, respectively, in those with low preoperative CRP levels (≤ 5.0 mg/mL). The difference in the survival rates of the 2 groups was significant (p = 0.004). Univariate survival analysis revealed that the preoperative CRP levels, TNM stage, tumor grade, drinking history, and anastomosis method were prognostic factors for overall survival (OS). Before conducting PSM, the low-CRP group had a lower age (p = 0.001), lower histological grade (p = 0.086), and lower TNM stage (p = 0.254).After PSM, 176 patients with low CRP levels and 176 of those with high CRP levels were enrolled in the analysis. In the matched cohort, the 3-year and 5-year survival rates were 56 and 50%, respectively, in patients with high preoperative CRP levels (> 5.0 mg/mL) and 68 and 56%, respectively, in those with low preoperative CRP levels (≤ 5.0 mg/mL). The difference in the survival rates between the low- and high-CRP groups was significant (p = 0.044). Multivariate analysis of the matched patients revealed that the TNM stage and preoperative CRP level were independent prognostic factors for OS.ConclusionsA high preoperative CRP level (> 5.0 mg/mL) predicts worse survival prognosis in patients who have undergone curative resection for esophageal squamous cell cancer.
Highlights
Esophageal cancer (EC) is a common cause of cancer-related deaths worldwide [1], and almost 50% of patients with EC live in China, where the most common histological type of this cancer is esophageal squamous cell carcinoma (ESCC) [2]
Creactive protein (CRP) is one of the acute-phase nonspecific proteins synthesized by the hepatocytes and regulated by interleukin-1, interleukin-6, and tumor necrosis factor (TNF) [11, 12]
Several reports have shown that a high preoperative serum CRP level is a disease-independent prognostic factor in a variety of tumors, such as those found in gastric cancer, lung cancer, renal cancer, and ovarian cancer [13,14,15,16,17]
Summary
Esophageal cancer (EC) is a common cause of cancer-related deaths worldwide [1], and almost 50% of patients with EC live in China, where the most common histological type of this cancer is esophageal squamous cell carcinoma (ESCC) [2]. Several reports have shown that a high preoperative serum CRP level is a disease-independent prognostic factor in a variety of tumors, such as those found in gastric cancer, lung cancer, renal cancer, and ovarian cancer [13,14,15,16,17]. There are reports on a relationship between preoperative serum CRP levels and the prognosis of EC [18,19,20,21,22]. These studies were conducted on a small number of patients, and the imbalances between the groups in these retrospective analyzes may have affected the results, resulting in indefinite conclusions. Owing to the inconsistent results, the role of serum CRP in EC remains controversial
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