The Prognostic Value of C-Reactive Protein Serum Levels in Patients with Uterine Leiomyosarcoma.

Richard Schwameis,Stephan Polterauer,Camilla Natter,Wolfgang Lamm,Michael Krainer,Heinz Koelbl,Alexander Reinthaller,Christoph Grimm,Edgar Petru,Christine Staudigl,Thomas Brodowicz,Gi Jin Kim

doi:10.1371/journal.pone.0133838

Richard Schwameis, Stephan Polterauer + Show 10 more

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https://doi.org/10.1371/journal.pone.0133838

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Abstract

ObjectiveC-reactive protein (CRP) has previously been shown to serve as a prognostic parameter in women with gynecologic malignancies. Due to the lack of valid prognostic markers for uterine leiomyosarcoma (ULMS) this study set out to investigate the value of pre-treatment CRP serum levels as prognostic parameter.MethodsData of women with ULMS were extracted from databases of three Austrian centres for gynaecologic oncology. Pre-treatment CRP serum levels were measured and correlated with clinico-pathological parameters. Univariate and multivariable survival analyses were performed.ResultsIn total, 53 patients with ULMS were included into the analysis. Mean (SD) CRP serum level was 3.46 mg/dL (3.96). Solely, an association between pre-treatment CRP serum levels and tumor size (p = 0.04) but no other clinic-pathologic parameter such as tumor stage (p = 0.16), or histological grade (p = 0.07), was observed. Univariate and multivariable survival analyses revealed that CRP serum levels (HR 2.7 [1.1–7.2], p = 0.037) and tumor stage (HR 6.1 [1.9–19.5], p = 0.002) were the only independent prognostic factors for overall survival (OS) in patients with ULMS. Patients with high pre-treatment CRP serum levels showed impaired OS compared to women with low levels (5-year-OS rates: 22.6% and 52.3%, p = 0.007).ConclusionHigh pre-treatment CRP serum levels were independently associated with impaired prognosis in women with ULMS and might serve as a prognostic parameter in these patients.

Highlights

Uterine leiomyosarcoma (ULMS) reflect the most common type of uterine sarcomas [1]
53 patients with uterine leiomyosarcoma (ULMS) were included into the analysis
Univariate and multivariable survival analyses revealed that C-reactive protein (CRP) serum levels (HR 2.7 [1.1–7.2], p = 0.037) and tumor stage (HR 6.1 [1.9–19.5], p = 0.002) were the only independent prognostic factors for overall survival (OS) in patients with ULMS

Summary

Introduction

Uterine leiomyosarcoma (ULMS) reflect the most common type of uterine sarcomas [1]. While the incidence of uterine sarcomas is slowly rising [2], ULMS still is a rare uterine malignancy with an incidence of 3–7 per 100,000 [3] and has orphan disease status in the national institute of healths’ list of orphan diseases and in orphanet. In rare and aggressive cancer types, such as ULMS, reliable prognostic parameters are of particular interest. Studies investigating clinical prognostic parameters such as tumor stage or histological grade in patients with ULMS have shown inconsistent results. Besides being induced in the acute phase of inflammatory response, CRP has been shown to be elevated in patients with a variety of cancer types and an association with prognosis was found. In particular elevated CRP serum levels have been associated with impaired survival in patients suffering from gynaecologic malignancies including cervical, ovarian, and endometrial cancer [7,8,9].

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