Abstract
The purpose of this study was to investigate an association between the prognosis for oro-hypopharynx squamous cell carcinoma treated with radiation therapy and the pre-therapeutic level of C-reactive protein (CRP). Patient with oro-hypopharyngeal squamous cell carcinoma who underwent definitive radiotherapy in our institution from January 2002 to August 2016 were enrolled. The patient were divided into elevated CRP (over 0.3 mg/dl) group and normal CRP groups, according to pre-treatment serum levels. There were 276 evaluable patients, and the median follow up was 41 months, ranging from 2 to 171 months. The 3-year OS and CSS for all enrolled patients were 67.0% and 72.8%, respectively. The OS and CSS rates were significantly worse in the elevated CRP group than in the normal CRP group, according to Kaplan-Meier survival curves analysed by a Log-rank test (p = 0.005 and p < 0.001, respectively). Multivariate analyses indicated that serum CRP levels remained independent predictors for both OS (HR: 1.588, p = 0.022) and CSS (HR: 1.989, p = 0.005). The pre-treatment CRP level is an independent predictor of treatment prognosis in patients with oro-hypopharyngeal cancer who underwent definitive radiotherapy. Especially, it is curious that an elevated CRP serum level is a significant predictor of loco-regional recurrence.
Highlights
C-reactive protein (CRP) belongs to a family of acute-phase proteins whose plasma concentrations increase in response to inflammation
We examined the factors of the primary site, age, gender, KPS, smoking history, current smoking status, clinical stages, anemia, pre-therapeutic CRP level and radiation treatment modalities
Among 303 consecutive eligible patients, we excluded 27 cases (8.9%) without any predictor, smoking data were missing for 3 patients, and CRP data were missing for 24 patients
Summary
C-reactive protein (CRP) belongs to a family of acute-phase proteins whose plasma concentrations increase in response to inflammation. Radiation therapy is a feasible and effective modality in the treatment of head and neck squamous cell cancer, especially in regard to organ preservation. Platinum-based chemo-radiotherapy, which is regarded as standard treatment in locally advanced cases, may be administered in two ways: induction or concurrent chemotherapy. A combination of cisplatin and 5-fluorouracil (CF regimen) has long been regarded as a standard in locally advanced head and neck cancer, in the TAX323 trial evaluating docetaxel, platinum plus 5-fluorouracil (DCF regimen) was superior to the CF regimen in survival and function preservation[12]. The prognostic role of CRP in patients with head and neck cancer is not fully understood. The purpose of this study was to investigate the relationship between serum CRP level and prognosis in oro-hypopharynx cancer patients treated by radiotherapy
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