Abstract
BackgroundSystemic inflammation plays a critical role in cancer progression and oncologic outcomes in cancer patients. We investigated whether preoperative inflammatory biomarkers, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil to lymphocyte ratio (NLR), could be surrogate biomarkers for predicting overall survival (OS) in soft tissue sarcoma (STS) patients treated with surgery and postoperative radiotherapy.MethodsA series of 99 patients who presented with localized extremity STS were retrospectively reviewed. The preoperative CRP levels, ESR, and NLR were evaluated for associations with OS, disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS). Cutoff values for CRP, ESR, and NLR were derived from receiver-operating characteristic curve analysis.ResultsElevated CRP (> 0.14 mg/dL), ESR (> 15 mm/h), and NLR (> 1.95) levels were seen in 33, 44, and 45 patients, respectively. Of these three inflammatory biomarkers, elevated CRP and ESR were associated with a poorer OS (CRP: P = 0.050; ESR: P = 0.001), DFS (CRP: P = 0.023; ESR: P = 0.003), and DMFS (CRP: P = 0.015; ESR: P = 0.001). By multivariate analysis, an elevated ESR was found to be an independent prognostic factor for OS (HR 3.580, P = 0.025) and DMFS (HR 3.850, P = 0.036) after adjustment for other established prognostic factors.ConclusionsThe preoperative ESR level is a simple and useful surrogate biomarker for predicting survival outcomes in STS patients and might improve the identification of high-risk patients of tumor relapse in clinical practice.
Highlights
Systemic inflammation plays a critical role in cancer progression and oncologic outcomes in cancer patients
In our current study, we assessed whether the preoperative serum C-reactive protein (CRP) levels, the erythrocyte sedimentation rate (ESR), and the neutrophil to lymphocyte ratio (NLR) could act as surrogate biomarkers for predicting overall survival (OS) in extremity soft tissue sarcoma (STS) patients treated with surgery and postoperative RT
We retrospectively reviewed the medical records of 99 patients who were treated with surgery and postoperative RT for primary localized STS of extremity between 2001 and 2013 at our institution
Summary
Systemic inflammation plays a critical role in cancer progression and oncologic outcomes in cancer patients. We investigated whether preoperative inflammatory biomarkers, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil to lymphocyte ratio (NLR), could be surrogate biomarkers for predicting overall survival (OS) in soft tissue sarcoma (STS) patients treated with surgery and postoperative radiotherapy. There is an urgent need for more readily available molecular biomarkers to improve the identification of STS patients at high risk of tumor relapse. It is evident that inflammatory responses play a critical role in tumor development, and some of the underlying molecular mechanisms have been elucidated. It is well recognized that chronic inflammation is a risk factor for most types of cancer. Inflammatory biomarkers might be used to predict cancer aggressiveness and monitor the progression
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