The association between preoperative serum C-reactive protein and hepatocellular carcinoma recurrence in patients with chronic hepatitis B virus (HBV) infection--a retrospective study.

Bobo Li,Jingyu Luo,Shuguang Liu,Daotang Li,Yitao Ding,Xiaoming Zhao

doi:10.1371/journal.pone.0116909

Abstract

The prognosis of the patients with hepatocellular carcinoma (HCC) recurrence following curative hepatectomy is usually dismal. Whether preoperative serum C-reactive protein (CRP) can predict the recurrence of HCC in patients with chronic HBV infection is not clear. Total 232 patients with chronic HBV infection were included in this retrospective study. We investigated the association between detailed preoperative serum CRP levels and early (≤ 2 year) and late (> 2 year) HCC recurrence following curative hepatectomy. After adjusting for potential confounders, we found a saturation effect for preoperative serum CRP of 2.1 mg/dl existed for early HCC recurrence (ER). The incidence of ER increased with preoperative serum CRP less than 2.1 mg/dl (OR = 3.5, 95% CI 1.6–7.6, P = 0.001), and higher preoperative serum CRP (>2.1 mg/dl) did not increase the incidence of ER (OR = 0.8, 95% CI 0.2–2.7, P = 0.703). Whereas there is a linear relationship between preoperative serum CRP and late HCC recurrence (LR) (OR = 0.2, 95% CI, 0.1- 0.4) (OR = 1.8, 95% CI, 1.2–2.5, P = 0.002). In addition, the optimal cutoff point for serum CRP level was 1.5 mg/dl, instead of 1.0 mg/dl, in predicting both ER and LR. Patients with higher preoperative serum CRP level (>1.5 mg/dl) had lower recurrence free survival rates and overall survival rates (P<0.01). These results suggest that preoperative serum CRP played different roles on ER and LR following curative hepatectomy, thus further predictingthe prognosis in patients with chronic HBV infection.

Highlights

Hepatocellular carcinoma (HCC) is the sixth most commonly diagnosed cancer and the third most common cause of cancer-related death worldwide[1]
Until the endpoint of the study, 85 of the 232 patients had no evidence of HCC recurrence with a median follow up of 65 months and 147 patients were documented as having HCC recurrence with a median follow up of 16 months
After investigating detailed preoperative serum C-reactive protein (CRP) levels contributing to early HCC recurrence (ER) and late HCC recurrence (LR) respectively, a linear relationship existed between preoperative serum CRP and LR, while this inflammation-related cytokine had a nonlinear relationship with ER

Summary

Introduction

Hepatocellular carcinoma (HCC) is the sixth most commonly diagnosed cancer and the third most common cause of cancer-related death worldwide[1]. The Association between Preoperative CRP and HCC Recurrence a curative treatment modality for HCC patients [2,3]. Serum CRP level has been found to be a prognostic indicator for gastric carcinoma [7], colorectal cancer [8] and esophageal carcinoma [9]. Some studies found that patients with HCC recurrence usually get higher levels of CRP [10,11]. To our knowledge, the detailed research regarding the correlation between serum CRP and the recurrence of HCC in patients with chronic HBV infection has not been found yet

Methods

Results

Conclusion