The Prognostic Value of Post-operative Serum C-reactive Protein Level for Survival after Surgery for Colorectal Liver Metastases

Abstract

Background : Increasing emphasis is put on the concept that inflammation is a key player in tumor progression. In the tumor microenvironment, inflammatory cells mediate tumor growth. Elevated C-reactive protein (CRP) levels are identified as being representative of a systemic inflammatory response. Therefore, studies have successfully linked peri-operative CRP levels to survival after surgery for primary colorectal cancer. The aim of this study was to investigate the prognostic value of the post-operative systemic inflammatory response as represented by serum CRP levels after resection of colorectal liver metastases (CRLM).Methods : Between January 2004 and December 2012, all patients who underwent resection for CRLM were analyzed. The total post-operative acute inflammatory response was objectified by the area under the curve (AUC, trapezium rule). Peak CRP concentrations were determined. The impact of peak CRP values and total CRP response on disease free survival (DFS) and overall survival (OS) was analyzed; patients were stratified by clinical risk score and/or administration of neo-adjuvant chemotherapy.Results : The final study population consisted of 403 patients. The OS of patients with a high CRP response (AUC, upper quartile) was equal to patients with intermediate (AUC, middle quartiles) or low (AUC, lower quartile) responses. Similarly, total post-operative CRP response did not impact survival when stratifying patients for CRS and/or administration of neo-adjuvant chemotherapy. Peak CRP concentrations did not impact survival accordantly.Conclusion : Total post-operative inflammatory response, as evidenced by CRP serum levels, had no prognostic value for survival after surgery for CRLM.