Abstract
BackgroundsSerum C-reactive protein (CRP) level has been shown to be a predictor of survival for multiple cancer types. The aim of this study was to evaluate whether pretreatment serum CRP level could serve as a reliable independent prognostic indicator for survival in patients with soft tissue sarcoma (STS).MethodsA detailed literature search was conducted in Medline, Embase and Cochrane for relevant research publications written in English. Patients’ clinical characteristics, outcomes of disease-specific survival (DSS) and disease/recurrence free survival (DFS/RFS) were extracted. Only the results of multivariate survival analysis were recruited in our analysis. Pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were calculated to evaluate the prognostic role of CRP. This study was registered on PROPERO and the registration number is CRD42018104802.ResultsNine articles containing 1655 patients were identified as eligible studies. The random effects model showed that elevated CRP level was significantly correlated with poor DSS (HR = 2.08; 95% CI: 1.33–3.24; p < 0.001). After excluding the heterogeneous study, the fixed effects model showed that elevated CRP level was firmly correlated with poor DSS (HR = 2.36; 95% CI: 1.84–3.03; p < 0.001). The fixed effects model revealed that elevated CRP level was significantly correlated with poor DFS (HR = 1.78; 95% CI: 1.39–2.30; p < 0.001) among studies have more than 100 samples.ConclusionThe results of this meta-analysis suggest that elevated pretreatment serum CRP level could serve as an independent risk factor for poor DSS and DFS/RFS in STS patents.
Highlights
Soft tissue sarcoma (STS) represents a heterogeneous group of tumors that arise predominantly from the embryonic mesoderm, with diverse subtypes and varying degrees of aggressiveness [1]
The random effects model showed that elevated C-reactive protein (CRP) level was significantly correlated with poor disease-specific survival (DSS) (HR = 2.08; 95% confidence intervals (CIs): 1.33–3.24; p < 0.001)
After excluding the heterogeneous study, the fixed effects model showed that elevated CRP level was firmly correlated with poor DSS (HR = 2.36; 95% CI: 1.84–3.03; p < 0.001)
Summary
Soft tissue sarcoma (STS) represents a heterogeneous group of tumors that arise predominantly from the embryonic mesoderm, with diverse subtypes and varying degrees of aggressiveness [1]. Traditional prognostic factors such as histologic grade, histological subtype, tumor size, tumor depth and anatomical location have been used to conduct risk assessment and make decisions regarding surgical strategy, adjuvant management and surveillance [2]. Tumor associated inflammatory responses may lead to alteration in cancer cell biology and activation of stromal cells in tumor microenvironment by upregulation of cytokines and inflammatory mediators, inhibition of apoptosis, induction of angiogenesis, stimulation of DNA damage and immunosuppression and remodeling of the extracellular matrix, promoting tumor growth and metastasis [4, 5]
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