Preoperative Serum C-reactive Protein Level Research Articles

Association between preoperative serum C-reactive protein level and leukocyte count and postoperative pain after otolaryngological surgery

PurposeTo determine whether the preoperative inflammatory serum C-reactive protein (CRP) and leukocyte count (LEUK) are associated with postoperative pain and complaints after otolaryngological surgery.MethodsRetrospective evaluation of 680 patients (33% female, median age 50 years) receiving otolaryngological surgery between November 2008 and March 2017 in a tertiary university hospital. Postoperative pain on the first postoperative day was assessed using the validated questionnaire of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including a numeric rating scale for assessment of postoperative pain (NRS, 0–10). The influence of preoperative parameters including CRP and LEUK on patients' postoperative pain was estimated.ResultsMean CRP value was 15.6 ± 34.6 mg/l and mean LEUK value 7.8 ± 3.2 Gpt/l. Patients with pharyngeal surgery had the highest CRP values (34.6 ± 52.9 mg/l), highest LEUK values (9.2 ± 4.2 Gpt/l) and the highest pain levels (3.1 ± 2.4 NRS) compared to all other surgical procedures (all p < 0.05). Higher postoperative pain was associated with LEUK values > 11.3 Gpt/l (r = 0.093, p = 0.016) and higher preoperative chronic pain (r = 0.127, p = 0.001). Multivariate analysis confirmed younger age, female gender, duration of surgery, preoperative chronic pain, type of surgery, and higher LEUK values > 11.3 as independent factors for postoperative pain. Perioperative antibiotics had no effect on the postoperative pain.ConclusionBeyond known factors, preoperative LEUK as inflammation marker is an independent predictor for pain on the first postoperative day.

What is the concordance rate of preoperative synovial fluid aspiration and intraoperative biopsy in detecting periprosthetic joint infection of the shoulder ?

The accuracy of preoperative synovial fluid culture for microbe detection in shoulder periprosthetic joint infection (PJI) is poorly described. To evaluate the utility of preoperative culture data for early pathogen identification for shoulder PJI, we determined the concordance between preoperative synovial fluid culture results and intraoperative tissue culture results. Fifty patients who met the 2014 Musculoskeletal Infection Society criteria for shoulder PJI between January 2016 and December 2019 were retrospectively reviewed for clinical and demographic data. This cohort of patients was divided in two groups based on the concordance between preoperative and intraoperative culture results. The pathogens identified on preoperative and intraoperative cultures were classified as high-virulence or low-virulence. Student's t tests and Mann-Whitney U tests were used as appropriate for continuous variables and chi-square and Fisher's exact tests were used as appropriate for categorical variables. Concordance between preoperative aspiration and intraoperative tissue culture was identified in 28 patients out of 50 (56%). Preoperative cultures positive for Gram-positive species were more likely to be concordant than discordant (p=0.015). Preoperative cultures positive for Cutibacterium acnes were more likely to be concordant with intraoperative cultures (p=0.022). There were more patients with polymicrobial infection in discordant group compared to concordant group (p<0.001). No statistically significant correlation between preoperative serum CRP level and intraoperative category of bacteria was reported. Staphylococcus aureus and coagulase-negative Staphylococci were associated with high specificity and negative predictive value (NPV). Preoperative cultures positive for Cutibacterium acnes demonstrated sensitivity, specificity, positive predictive value (PPV) and NPV lower than 0.8. Gram-negative pathogens demonstrated the highest sensitivity (1) and specificity (1), while polymicrobial infections exhibited the lowest sensitivity and PPV. Preoperative synovial fluid aspiration for shoulder PJI poorly predicts intraoperative culture results, with discordance of 44%. More favorable concordance was observed for monomicrobial preoperative cultures, particularly for Gram-negative organisms and methicillin-sensitive Staphylococcus aureus. The overall high rate of discordance between preoperative and intraoperative culture may prompt surgeons to base medical and surgical management on patient history and other factors and avoid relying solely on preoperative synovial fluid culture data.

Accuracy of C-Reactive Protein Level in the Diagnosis of Acute Appendicitis on Histopathology

Background: Acute appendicitis (AA) is one among most common condition requiring emergency surgery throughout the world. Acute appendicitis most common diagnosis in patients seeking medical help in emergency room due to acute abdomen causing 72,000 deaths among 16 million cases reported globally. This study will help the surgeons in making timely decisions, thus reducing the morbidity and mortality associated with complicated appendicitis. The aim of this study was to accuracy of C - reactive protein (CRP) levels in acute appendicitis. Material and Methods: Six-month descriptive cross-sectional research from 16 February to 16 August 2019 was completed. The Khyber Teaching Hospital in Peshawar served as the study's location. A total of 216 patients were monitored throughout this investigation. The history, clinical examination, and regular laboratory tests, such as the total leucocyte count (TLC) and differential leucocyte count (DLC) on admission, were used to make the diagnosis of acute appendicitis. All of these patients were given Nil by Mouth to prepare them for emergency surgery, and baseline testing included HBs Ag and Anti-HCV serology as well as pre-operative serum CRP levels (Liver function tests, renal function tests and serum electrolytes). Following preparation, every patient on the emergency list had surgery. Intra-operative results were recorded, and a biopsy was collected from the excised appendices and forward to histopathology for further processing. Results: The mean age in this research was 48 years, with an SD of 12.311. Male patients made up 55% of the total population, while female patients made up 45%. The diagnostic accuracy of C-reactive protein levels was determined to be 84.2% in this study. The specificity was found to be 33.3%, while the sensitivity was observed to be 85.7%. By using histopathology, it was discovered that the positive predictive value was 97.2% and the negative predictive value was 84.2%. Conclusion: According to our study, using histopathology, the diagnostic accuracy of C-reactive protein levels was 84.25% with sensitivity of 85.71%, specificity of 33.33%, and positive predictive values of 97.25% and 184.25%. The findings will also open the door for any further research in this area. . The higher CRP levels will therefore predict the complexity of acute appendicitis and help the general practitioners to do early referrals therefore avoiding life threatening complications Keywords: Acute Appendicitis, C-Reactive Protein, Histopathology, CRP, Gold Standard

Editors' Note: Shoulder-Tap Test for Functional Gait Disorders: A Sign of Abnormal Anticipatory Behavior

We evaluated the significance of the preoperative serum C-reactive protein (CRP) level as a prognostic indicator in patients with non-small cell lung cancer (NSCLC). Patients and Methods: Two hundred and three patients who had undergone a curative resection of NSCLC were retrospectively reviewed. Results: The proportion of the tumor size over 3 cm per patient in the CRP-positive group (≥0.5 mg/dL: n=38) was significantly higher than that in the CRP-negative group (&lt;0.5 mg/dL: n=165). The proportion of the adenocarcinoma in CRP-positive group was significantly lower than that in CRP-negative group. The overall and disease specific survival rates in the CRP-positive group were significantly lower than the rates in the CRP-negative group. Based on a multivariate analysis, the preoperative serum CRP level was selected as one of the unfavorable indicators regarding survival. Conclusion: The preoperative serum CRP level is an independent and significant indicator predictive of a poor prognosis in patients with NSCLC.

Prognostic impact of preoperative Geriatric Nutritional Risk Index in oral squamous cell carcinoma.

To investigate the prognostic impact of preoperative Geriatric Nutritional Risk Index (GNRI) values in older adults undergoing radical surgery for oral squamous cell carcinoma (OSCC). This retrospective study included 61 patients ≥65 years old with OSCC (43 men, 18 women; age: 72.1 ± 5.4 years) who underwent radical surgery between 2013 and 2020. Factors influencing overall survival (OS) and disease-free survival (DFS) were examined. Receiver operating characteristic curve analysis indicated that the optimal GNRI value for classifying patients into low-GNRI (<93.7; OS: n=19 [31.1%], DFS: n=42 [68.9%]) and high-GNRI groups (≥93.7; OS, n=19 [31.1%]; DFS, n=42 [68.9%]) was 93.7. OS and DFS rates were significantly lower in the low-GNRI group than in the high-GNRI group. Univariate analysis indicated that alcohol use, preoperative serum C-reactive protein level, lymphatic invasion, postoperative treatment, and GNRI were significantly correlated with OS, while lymphatic invasion, postoperative treatment, and GNRI were significantly correlated with DFS. In multivariate analysis, only GNRI was significantly correlated with OS. DFS and postoperative treatment were independent predictors of DFS. Preoperative GNRI may be a significant prognostic factor in older adults with OSCC. GNRI assessment and nutritional intervention may improve prognosis in patients at high nutritional risk.

Evaluation and Correlation of Preoperative Serum C- Reactive Protein, Neutrophil-lymphocyte Ratio and Platelet-lymphocyte Ratio for Cervical Metastasis in Patients of Primary Oral Squamous Cell Carcinoma

Background: The influence of cervical metastasis on prognosis in a person who is suffering from oral squamous cell carcinoma (OSCC) has been notorious. C- reactive protein (CRP) is a prior biomarker for inflammation. Recent literature provide evidence of systemic inflammatory markers playing important role in determining survival rate on patient with OSCC. Hence, in current study the “utility of Neutrophil-lymphocyte ratio (NLR) ,Platelet-lymphocyte ratio (PLR), and serum CRP are evaluated and correlated for cervical metastasis”.&#x0D; Objectives: This study intends to evaluate and correlate preoperative serum CRP, NLR, and PLR for cervical metastasis in patients of primary oral squamous cell carcinoma.&#x0D; Methodology: The clinicopathological data, CRP and the preoperative complete blood investigation details were obtained from 40 primary OSCC patients who will undergo surgery. The optimal cut-off value of CRP, PLR and NLR was determined. The prognostic significance of markers will be determined by Univariate and multivariate analysis.&#x0D; Expected Results: The elevation of CRP, NLR, and PLR levels will significantly evaluate and correlate with cervical metastasis.&#x0D; Conclusion: Preoperative serum CRP, NLR, and PLR level will be a prognosticator in OSCC.

The Natural Course of Serum D-Dimer, C-Reactive Protein, and Erythrocyte Sedimentation Rate Levels After Uneventful Primary Total Joint Arthroplasty

BackgroundThis study aimed to assess the baseline levels of D-dimer, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) and monitor the natural course of these serum markers after uneventful primary total joint arthroplasty. MethodsThis prospective study enrolled 81 patients undergoing primary total knee arthroplasty or total hip arthroplasty. The level of serum D-dimer, CRP, and ESR was measured preoperatively and on postoperative days 1, 3, 5, 15, and 45. Mean peak values, peak times, and distribution were compared between D-Dimer, CRP, and ESR. ResultsThe mean preoperative serum D-dimer, CRP, and ESR level was 412 ± 260 (range 200-980) ng/mL, 2.93 ± 2.1 (range 1-18) mg/L, and 22.88 ± 17.5 (range 3-102) mm/h, respectively. The highest mean peak for D-dimer, CRP, and ESR was at postoperative day 1, 3, and 5, respectively. ConclusionD-dimer levels reached peak levels on postoperative day 1 and then declined rapidly to a plateau level by postoperative day 3. A second, albeit small, peak in the level of D-dimer occurred on postoperative day 15. The level of CRP and ESR remained elevated for much longer with CRP returning to baseline on postoperative day 45 and the level of ESR had not returned back to normal on postoperative day 45.

Postoperative delirium in patients undergoing surgery for bone metastases.

Postoperative delirium (PD), characterized by acute onset of global impairment in consciousness and cognition, is a common complication following major surgeries and is often associated with adverse outcomes. Because of the multiple comorbidities of the patient along with extensive nature of the surgery, patients undergoing surgery for bone metastases may be prone to developing PD. However, no study exists regarding PD in patients who undergo surgery for bone metastases.Two hundred seventy six patients with mean age of 64 years (range, 16–94) who underwent surgery for bone metastases were reviewed. The diagnosis of PD was made by the psychiatrist, according to fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. Possible perioperative clinic-pathologic factors that may be associated with the development of PD were investigated.Among the 276 patients, 9% (n = 25) developed PD. On multivariate logistic regression analysis, history of psychiatric disorders (odds ratio [OR] = 9.63; 95% confidence interval [CI] 1.78–21.74, P = .004), high preoperative serum C-reactive protein (CRP) level (OR = 1.17; 95% CI 1.06–1.29, P = .001), low preoperative serum albumin level (OR = 0.13; 95% CI 0.03–0.48, P = 0.002), and high dose of opioid analgesics received in the immediate postoperative period (OR = 1.05; 95% CI 1.01–1.07, P = .001) were independently associated with the development of PD. Patients with PD had lower survival (log rank, P = .001) than patients without PD.Incidence of PD is considerable in patients undergoing surgery for bone metastases. History of psychiatric disorders, preoperative serum albumin and CRP levels, and the dose of postoperative opioid analgesics are associated with the development of PD.

Preoperative serum C-reactive protein levels and postoperative survival in patients with esophageal squamous cell carcinoma: a propensity score matching analysis

ObjectivesThis study tested the relationship between preoperative serum C-reactive protein (CRP) levels and cancer-specific prognosis in patients with esophageal squamous cell carcinoma who have undergone curative resection.MethodsWe conducted a retrospective study on 961 patients with esophageal squamous cell cancer who underwent curative esophagectomy from 2006 to 2012 at the Sun Yat-sen University Cancer Center. Preoperative serum CRP levels were determined, and a cutoff value of 5.0 mg/mL was established. Propensity score matching (PSM) was performed to reduce the selection bias between patients with low CRP (≤ 5.0 mg/mL) and those with high CRP (> 5.0 mg/mL) levels based on age, tumor-lymph node-metastasis (TNM) stage, and tumor grade. The prognostic value of preoperative CRP levels was determined using life table, Kaplan–Meier, and Cox proportional hazards analyzes.ResultsIn the unmatched cohort, the 3-year and 5-year survival rates were 57 and 53%, respectively, in patients with high preoperative CRP levels (> 5.0 mg/mL) and 68 and 56%, respectively, in those with low preoperative CRP levels (≤ 5.0 mg/mL). The difference in the survival rates of the 2 groups was significant (p = 0.004). Univariate survival analysis revealed that the preoperative CRP levels, TNM stage, tumor grade, drinking history, and anastomosis method were prognostic factors for overall survival (OS). Before conducting PSM, the low-CRP group had a lower age (p = 0.001), lower histological grade (p = 0.086), and lower TNM stage (p = 0.254).After PSM, 176 patients with low CRP levels and 176 of those with high CRP levels were enrolled in the analysis. In the matched cohort, the 3-year and 5-year survival rates were 56 and 50%, respectively, in patients with high preoperative CRP levels (> 5.0 mg/mL) and 68 and 56%, respectively, in those with low preoperative CRP levels (≤ 5.0 mg/mL). The difference in the survival rates between the low- and high-CRP groups was significant (p = 0.044). Multivariate analysis of the matched patients revealed that the TNM stage and preoperative CRP level were independent prognostic factors for OS.ConclusionsA high preoperative CRP level (> 5.0 mg/mL) predicts worse survival prognosis in patients who have undergone curative resection for esophageal squamous cell cancer.

Peripheral blood inflammatory parameters in patients with colorectal cancer

Introduction. Colorectal cancer is the third most common cancer worldwide. The introduction of novel diagnostic and treatment methods has resulted in decreasing mortality rates; however, an increase in morbidity is observed. Severe inflammation plays an important role in many aspects associated with carcinogenesis. Neoplasia and inflammatory response are mutually related. Aim. The aim of the study was to evaluate the association between preoperative serum C-reactive protein levels and total leukocyte count in colorectal cancer patients in comparison with postoperative histopathological findings depending on whether there was neoplastic infiltration of the local adipose tissue or not. Material and methods. The study population included 50 patients with colon cancer. Exclusion criteria were distant metastases, neoadjuvant therapy and a past history of cancer diagnosis. Blood findings were compared with histopathology. Patients were divided into two groups – with and without neoplastic infiltration of fat tissue in histopathology. Results. Serum C-reactive protein levels were evaluated in all patients. The tested indicator was higher in the group with infiltration, but was not statistically significant. Additionally, the WBC count was normal in both groups, but it was lower in the group with infiltration, and the result was statistically significant. Conclusions. C-reactive protein level and total leukocyte count can be a helpful and supportive marker in staging in colorectal cancer patients. Owing to the wide availability and low cost of the above mentioned blood tests, they may be easily performed in daily medical practice. The decrease in the total leukocyte count was proportional with higher cancer stage; therefore, it needs to be further investigated.

Higher Serum C-reactive Protein Level Represents the Immunosuppressive Tumor Microenvironment in Patients With Clear Cell Renal Cell Carcinoma.

C-reactive protein (CRP), a representative inflammatory marker, could serve as a biomarker in renal cell carcinoma because CRP is an important prognostic factor. However, its detailed mechanism remains unknown. This study showed that higher CRP levels correlated with the tumor immune microenvironment, which leads to a worse prognosis. These findings can help to clarify the underlying mechanisms between the presence of systemic inflammatory reaction and prognosis. The aim of this study is to investigate the association between tumor immune microenvironment and CRP in patients with renal cell carcinoma (RCC) to explore the underlying mechanisms between CRP level and prognosis. Immunohistochemical measurement of CD4, CD8, CD163 (M2 macrophages), and Foxp3 (Regulatory T [Treg] cells) was performed in patients with clear-cell RCC (n= 111) treated with radical or partial nephrectomy at our institution. The association between immunohistochemical status and preoperative serum CRP level and cancer-specific survival (CSS) was analyzed. Thirty-three patients (30%) had a high CRP level (≥ 5.0 mg/L), and the CSS rate was significantly worse among these patients than among the remaining patients (P< .001). In patients with strong infiltration of CD8+, Foxp3+, or CD163+ cells, CRP levels were significantly higher (P= .041, P= .001, and P= .035, respectively), and CSS was significantly worse compared with patients with weak infiltration (P= .040, P= .026, and P< .001, respectively). In multivariate analysis, strong CD163+ cells infiltration (P= .001) as well as pathologic T3 (P= .036), lymph-node involvement (P= .007), distant metastasis (P< .001), and Fuhrman nuclear grade 4 (P= .003) were independent prognostic factors for CSS. Infiltration of the immunosuppressive cells known as Tregs and M2 macrophages in the tumor microenvironment is associated with higher CRP and poor prognosis in patients with clear-cell RCC. CRP could reflect an immunosuppressive microenvironment.

Relationship Between Visceral Obesity and Postoperative Inflammatory Response Following Minimally Invasive Esophagectomy.

Esophagectomy for esophageal cancer is one of the most invasive surgeries. However, the factors influencing postoperative systemic inflammatory response following esophagectomy have not been elucidated. Recently, visceral fat has been shown to play an important role in both chronic and acute inflammation. In this study, we assessed the relationship between visceral obesity and postoperative inflammatory response following minimally invasive esophagectomy (MIE). Visceral fat area (VFA) was measured using computed tomography in 152 patients undergoing MIE for esophageal cancer. We assessed perioperative serum C-reactive protein (CRP) levels preoperatively and on postoperative days (PODs) 1-5 and analyzed the relationship between VFA and perioperative serum CRP levels. VFA was positively associated with preoperative serum CRP level (P < 0.001). Univariate analysis revealed that VFA was significantly associated with increased serum CRP levels on PODs 1-5 (P < 0.001 for each day), whereas multivariate analysis revealed that it was independently associated with increased serum CRP levels on PODs 1-4 (P = 0.033, 0.035, 0.001, and 0.006, respectively). Similar results were observed in patients who did not have postoperative infectious complications, such as pneumonia, anastomotic leak, and surgical site infection. VFA was not an independent risk factor for the occurrence of these postoperative infectious complications. Visceral obesity might be associated with chronic inflammation in patients with esophageal cancer and promote postoperative inflammatory response following MIE.

Clinical significance of preoperative serum C-reactive protein in oral squamous cell carcinoma

C-reactive protein (CRP) is an index of systemic inflammation. However, CRP is not usually assessed preoperatively. Hence the study intended to evaluate the preoperative serum CRP levels in oral squamous cell carcinoma (OSCC) patients and to analyse its relationship with the clinicopathologic characteristics. CRP values for 60 OSCCs and 30 healthy controls were evaluated using a CRP assessment kit and spectrophotometer. The Mann–Whitney U test, χ2 test, receiver operating characteristic (ROC) curve analysis, and logistic regression were applied. The CRP ranged from 0.3 to 86mg/L in OSCCs. CRP was significantly higher in OSCCs than in controls. A raised CRP was seen in 70% of OSCCs. CRP in OSCCs was associated with clinical nodal status and lymph node metastasis (LNM) (P<0.05). CRP was significantly higher in the metastatic than in the non-metastatic group. The area under the ROC was 0.819. The best cut-off value for predicting LNM was 8.65mg/L for the CRP with 0.767 sensitivity and 0.767 specificity (P<0.05). The cut-off revealed a significant association with LNM. Raised CRP may predict LNM. The CRP levels regressed significantly in relation to LNM. CRP could offer prognostic information beyond staging and histology. Hence, CRP can be added as an extension to known clinicopathologic parameters to predict the prognosis in OSCCs.

Prognostic implications of plasma fibrinogen and serum Creactive protein levels in non-small cell lung cancer resection and survival

Purpose : To investigate the prognostic implications of plasma fibrinogen and serum C-reactive protein (CRP) levels in tumour resection and survival following successful tumour resection in patients with nonsmall cell lung cancer (NSCLC). Methods : One hundred and fifty-three NSCLC patients who underwent surgical resection at a tertiary care hospital from January 2006 through December 2010 were enrolled. Pre-operative serum CRP and plasma fibrinogen levels were measured. The levels of these biomarkers correlated with tumour size and pathologic TNM stage. The possibility of complete resection and associated findings are reported. Results : Plasma fibrinogen (r = 0.381, p = 0.002) and serum CRP (r = 0.471, p < 0.001) levels were positively associated with tumour diameter. Increased levels of these biomarkers were significantly associated with sex, smoking status, histological type, tumour stage, and clinical stage. Partial tumour resection occurred in 28 % (27/95) of patients with an increased plasma fibrinogen level compared to 10 % (6/58) with a normal fibrinogen level (p = 0.008), and in 30 % (29/97) of patients with an increased serum CRP level compared to 11 % (6/56) with a normal CRP level (p = 0.006). Patients with elevated CRP and fibrinogen concentrations demonstrated higher susceptibility to disease advancement and survival compared to patients with normal fibrinogen and CRP levels. Conclusion : Pre-operative functional concentrations of serum CRP and plasma fibrinogen could serve as indicators of tumour resectability wherein a high tumour resection rate is possible in patients with favourable pre-operative levels of these biomarkers. Increased concentrations of serum CRP and plasma fibrinogen are associated with poor overall survival and progression-free survival. Key words : Plasma fibrinogen, serum C-reactive protein, biomarker, non-small cell lung cancer

The efficacy of stratifying patients with laparoscopic gastrectomy at age, body mass index and preoperative serum C-reactive protein level for predicting an incidence ratio of postoperative complications.

31 Background: Wide variety of Predictive factors (PF) of postoperative complications (PC) in patients with gastric cancer(GC) that have undergone laparoscopic gastrectomy(LG) has been reported. The aim of this study is to devise simple PF for PC for LG that can estimate risk of PC preoperatively. Methods: Two hundred and ninety-eight patients that have been underwent curative LG against GC during May 2012 to March 2016 were enrolled. Patients’ characteristics, preoperative (pre-) laboratory data, operative information and pathological factors were analyzed. Also PC with Clavien-Dindo classification Grade (CD)≥II (PC≥II), pancreatic fistula (PF), intraabdominal abscess (IA), pneumonia (PN) and anastomotic leakage (AL) with CD≥III were examined. Results: Patients with pStage I, II, III and IV was 83%, 11%, 5.6% and 0.4%, respectively. Patients with PC≥II, PF or IA, PN and AL was 17.4%, 5%, 1% and 2.3%, respectively. Patients with PC≥II were significantly elder (p=0.01) and had higher pre-serum-C-reactive protein level (CRP) (p=0.02). Also, patients with AL had significantly higher Body Mass Index (BMI) (p=0.04). We devised “ABC score” by Age, BMI and CRP. It is defined as a number of factors in age, BMI and CRP that are higher than cutoff value of 66 years’ old, 23 kg/m2 and 0.04 mg/dL, respectively. Patients with ABCs 0, 1, 2, and 3 were 26%, 33%, 34% and 7%, respectively. Patients with ABCs 3 had significant high risk of PC≥II and AL (HR 2.8, p=0.03 and HR 9.9, p=0.004, respectively). Also we found higher ABCs has higher risk of AL (HR1.2, p=0.07 for ABCs 2 and HR2.2, p=0.04 for ABCs 3). Conclusions: ABCs can be a PF for PC in patients with LG. Especially it may evaluate an incidence ratio of AL.

C-reactive protein (CRP) as a prognostic factor for colorectal cancer after surgical resection of pulmonary metastases

Pulmonary metastases occur in up to 25% of colorectal cancer (CRC) patients. Many studies have reported that pulmonary metastasectomy might increase 5-year survival of these patients. The aim of this study was to describe our experience with pulmonary metastasectomy for metastatic colorectal cancer and to explore the prognostic value of serum C-reactive protein (CRP) and other factors. Between June 2002 and December 2013, the clinicopathological data of 88 patients who underwent resection of pulmonary metastases from colorectal carcinoma were retrospectively reviewed and analyzed. Clinical, investigative and operative data were prospectively collected. Overall survival (OS) was calculated from resection of pulmonary metastases to death. There were 58 men and 30 women in this study, and their median age was 55 (range 31 to 85). Video-assisted thoracoscopic surgery (VATS) was performed in 59 cases (78%) and 29 patients (19%) underwent thoracotomy. Lung wedge resection and pulmonary lobectomy were performed in 52 (59.1%) and 36 patients (40.9%), respectively. Preoperative elevated CRP was present in 8 (9.1%) patients. After a median follow-up duration of 44 months, the cumulative 5-year survival was 45.4% and the median overall survival (OS) was 57.8 months. A significantly longer survival was observed in patients with normal preoperative CRP level compared with those with CRP level exceeding 10mg/L (62.6 months vs. 34.3 months, P=0.011). In multivariate analysis, preoperative CRP level was found to be independent significant prognostic factors for survival. Pulmonary resection of metastatic colorectal cancer might offer a chance to prolong survival including those patients with extrapulmonary metastasis. Preoperative serum CRP level was identified as prognosis-related factor for surgery.

Cumulative score based on preoperative plasma fibrinogen and serum C-reactive protein could predict long-term survival for esophageal squamous cell carcinoma.

The present study was to establish a prognostic indicator based on preoperative fibrinogen and C-reactive protein (CRP) (FC score) in esophageal squamous cell carcinoma (ESCC). Clinicopathologic characteristics, preoperative plasma fibrinogen and serum CRP levels were reviewed in patients who underwent transthoracic esophagectomy. The optimal cut-off value for fibrinogen and CRP was defined as 4.0 g/dL and 10.0 mg/L according to previous reports. Patients with elevated fibrinogen and CRP levels were assigned a score of 2, those with only one of these two abnormalities were allocated a score of 1, and those with neither of the two abnormalities were assigned a score of 0. Preoperative FC score was significantly correlated with degree of differentiation, depth of invasion, tumor-node-metastasis (TNM) stage and modified Glasgow Prognostic Score (mGPS). No significant differences in age, gender, tumor length, tumor location, lymph node status or smoking were identified between groups. Univariate survival analysis demonstrated that high preoperative FC score (1/2) was significantly associated with impaired disease free survival (DFS) [hazard ratio (HR), 1.650; 95% confidence interval (CI), 1.181-2.303; P = 0.003] and overall survival (OS) (HR, 1.879; 95% CI, 1.333-2.648; P<0.001), and it remained an independent predictor for both DFS (HR, 1.468; 95% CI, 1.043-2.067; P=0.028) and OS (HR, 2.070; 95% CI, 1.266-3.385; P=0.004) in multivariate Cox regression analysis. Preoperative FC score might represent a new potential marker of worst prognosis that warrants further evaluation in prospective and large cohort studies among ESCC patients who underwent transthoracic esophagectomy.

Evaluation of interleukin-6 and C-reactive protein in patients with breast cancer at Menoufia University Hospitals

Objectives: The aim of this study was to determine the serum level of interleukin-6 (IL-6) and C-reactive protein (CRP) in patients with breast cancer and to correlate them with the staging of the disease. Background: Breast cancer is a disease that continues to plague women. IL-6 and CRP are found to be elevated in various inflammatory and malignant diseases, and their levels are found to correlate with the extent of the disease. Patients and methods: A total of 39 female patients with breast cancer were identified for the study. Serum level of IL-6 was assessed with enzyme-linked immunosorbent assay, and CRP was measured by means of immunoturbidimetry. The patients were classified into six groups on the basis of the pathological Tumor-Node-Metastasis (TNM) system. Statistical analyses of the data were then processed. Results: Increase in cancer invasion and staging are generally associated with increase in preoperative serum IL-6 and CRP level. IL-6 and CRP level correlate with lymph node metastasis (P > 0.001) and distant metastasis (P > 0.001). Serum IL-6 and CRP level correlate with TNM staging (P > 0.001). Conclusion: The levels of IL-6 and CRP have a positive correlation with the TNM staging system of breast cancer. Hence, IL-6 and CRP could be used as parameters to assess the prognosis of breast cancer patients.

Factors affecting surgical site infection rate after elective gastric cancer surgery.

Surgical site infection (SSI) is a common complication after surgery and is an indicator of quality of care. Risk factors for SSI are studied thoroughly for most types of gastrointestinal surgeries and especially colorectal surgeries, but accumulated data is still lacking for gastric surgeries. We studied the parameters affecting SSI rate after gastric cancer surgery. Consecutive patients, who underwent elective gastric cancer surgery between June and December 2013, were included. Descriptive parameters, laboratory values and past medical histories were recorded prospectively. All patients were followed for 1 month. Recorded parameters were compared between the SSI (+) and SSI (-) groups. Fifty-two patients (mean age: 58.87±9.25 [31-80]; 67% male) were included. SSI incidence was 19%. ASA score ≥3 (p<0.001), postoperative weight gain (p<0.001), smoking (p=0.014) and body mass index (BMI) ≥30 (p=0.025) were related with a higher SSI incidence. Also patients in the SSI (+) group had a higher preoperative serum C-reactive protein level (p=0.014). We assume that decreasing BMI to <30, stopping smoking at least 3 weeks before the operation, and preventing postoperative weight gain by avoiding excessive intravenous hydration will all help decrease SSI rate after gastric surgery.

Do preoperative serum C-reactive protein levels predict the definitive pathological stage in patients with clinically localized prostate cancer?

The serum C-reactive protein (CRP) level correlates with the clinical prognosis in patients with kidney, penile and metastatic castration-resistant prostate cancer (PC). We prospectively evaluated the preoperative CRP level as a predictive marker for an advanced tumor stage or high-grade cancer in patients with clinically localized PC. The study evaluated 629 patients with clinically localized PC who underwent radical prostatectomy between 2010 and 2013. Exclusion criteria were signs of systemic infection, symptoms of an autoimmune disease or neoadjuvant androgen deprivation. Poorly differentiated PC tends to be more common in patients with elevated CRP levels (15.5 vs. 9.5%, p = 0.08). Analogously, patients with a Gleason score ≥8 PC had significantly higher median CRP levels than those with a Gleason score ≤7 PC (1.9 vs. 1.2 mg/l, p = 0.03). However, neither uni- nor multivariate analysis showed an association between the preoperative CRP level and the presence of a locally advanced tumor stage, lymph node metastases or a positive surgical margin. CRP also failed to correlate with the initial PSA level and the clinical tumor-associated findings. Moreover, multivariate analysis relativized the association between an elevated CRP level and poor tumor differentiation. In patients with clinically localized PC, CRP does not appear to possess the predictive value and it was shown to have patients with other tumor entities or advanced PC.