C-reactive Protein in HPV-Positive and HPV-Negative Oropharyngeal Cancer

Objective Evaluate serum C-reactive protein (CRP) in human papillomavirus (HPV)–positive oropharynx cancer as compared with HPV-negative oropharynx cancer and determine if CRP levels were associated with overall survival and/or recurrence-free survival. Study Design Prospective cohort study. Setting Tertiary care academic cancer center between 2007 and 2010. Subjects and Methods Among patients with oropharynx cancer and confirmed HPV status, plasma CRP levels were measured with a high-sensitivity ELISA kit. Multivariable logistic regression analysis compared 4 categories of CRP (low, moderate, high, very high) between the HPV-positive and HPV-negative groups. Kaplan-Meier methods and Cox regression models were used to determine overall survival and recurrence-free survival by CRP level in both populations. Results Between 113 HPV-positive and 110 HPV-negative patients, CRP levels were significantly higher in the HPV-positive group, but these levels did not demonstrate a statistically significant dose-response trend. Higher CRP levels were also associated with reduced overall survival ( P = .016) and recurrence-free survival ( P < .001) within the HPV-negative group in univariable analysis; in multivariate analysis, the comparisons were not significantly different. Within HPV-positive oropharynx cancer, CRP levels were not significantly associated with overall survival or recurrence-free survival in univariable or multivariable analyses. Conclusion Circulating CRP was higher in HPV-positive versus HPV-negative oropharynx cancer. Among HPV-negative patients, higher CRP levels were associated with reduced survival.

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Association of elevated C-reactive protein with oncologic outcomes in renal CELL carcinoma: A multicenter analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.596 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 596-596

Author(s):

Sunil Hemant Patel ◽

Margaret Frances Meagher ◽

Kazutaka Saito ◽

Dattatraya Patil ◽

Ahmet Bindayi ◽

...

Keyword(s):

Overall Survival ◽

Tumor Size ◽

Tumor Grade ◽

Recurrence Free Survival ◽

C Reactive Protein ◽

Free Survival ◽

Reactive Protein ◽

Multicenter Cohort ◽

Independent Risk Factors ◽

Pre Treatment

596 Background: C-reactive protein (CRP) is a systemic inflammatory marker which has been associated with overall survival (OS) in Renal Cell Carcinoma (RCC) patients in Asia. Data supporting utility of CRP as a predictive marker in non-Asian populations are sparse and controversial. We analyzed utility of pre-treatment CRP as a predictor of survival and oncological outcomes in a multicenter cohort of RCC patients. Methods: Retrospective international 3 center analysis of patients of patients with RCC with pretreatment CRP values from 2006-2017. CRP > 0.5mg/dl was used as threshold for elevation and the cohort was subdivided into two groups for descriptive analysis (normal-CRP ≤0.5 and elevated-CRP > 0.5). Primary outcome was recurrence-free survival (RFS). Secondary outcome was overall survival (OS). Kaplan-Meier (KMA) and multivariable analyses (MVA) were utilized to delineate survival outcomes and their predictors. Results: Overall 2695 patients were analyzed (1791 Male/904 female, CRP≤0.5 1198/CRP > 0.5 1496; mean follow-up 36 months). Patients with elevated CRP had higher incidence of hypertension (p = 0.001), BMI (p < 0.001), and tumor size (3.91 cm vs. 6.05 cm, p < 0.001). MVA for RFS demonstrated elevated CRP (OR = 0.542, p = 0.005), increasing tumor size (OR = 0.915, p < 0.001), and high tumor grade (OR = 0.322 p < 0.001) to be independent risk factors. MVA for all-cause mortality demonstrated elevated CRP (OR = 12.396, p = 0.005), increasing tumor size (OR = 1.126, p < 0.001), high tumor grade (OR = 2.474, p < 0.001), and receipt of PN (OR = 1.826, p = 0.001) to be independent risk factors. For normal vs. elevated CRP, KMA revealed 5-year RFS of 90% vs. 85% (p = 0.001), 95% vs 85% (p = 0.163), 85% vs 62% (p = 0.001), 50% vs 60% (p = 0.513) for Stages 1, 2, 3, and 4, respectively. KMA revealed 5-year OS of 98% vs 80% (p = 0.001), 95% vs 80% (p = 0.103), 95% vs 65% (p = 0.001), 99% vs 40% (p < 0.001) for Stages 1, 2, 3, and 4, respectively. Conclusions: Pre-treatment CRP was an independent predictor of recurrence free survival and overall survival in a multicenter cohort of RCC patients. While further confirmation is requisite, our findings suggest incorporation of CRP into nomographic and risk stratification protocols.

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Mid-regional proadrenomedullin (MR-proADM), C-reactive protein (CRP) and other biomarkers in the early identification of disease progression in patients with COVID-19 in the acute NHS setting

Journal of Clinical Pathology ◽

10.1136/jclinpath-2021-207750 ◽

2022 ◽

pp. jclinpath-2021-207750

Author(s):

Nathan Moore ◽

Rebecca Williams ◽

Matilde Mori ◽

Beatrice Bertolusso ◽

Gabrielle Vernet ◽

...

Keyword(s):

Critical Care ◽

Disease Progression ◽

Cox Regression ◽

White Cell Count ◽

Tertiary Care ◽

C Reactive Protein ◽

Reactive Protein ◽

Non Invasive Ventilation ◽

Increased Risk ◽

Critical Care Admission

AimsThere is a lack of biomarkers validated for assessing clinical deterioration in patients with COVID-19 on presentation to secondary or tertiary care. This evaluation looked at the potential clinical application of C reactive protein (CRP), procalcitonin, mid-regional proadrenomedullin (MR-proADM) and white cell count to support prediction of clinical outcomes.Methods135 patients presenting to Hampshire Hospitals NHS Foundation Trust between April and June 2020 confirmed to have COVID-19 via reverse-transcription-qPCR were included. Biomarkers from within 24 hours of presentation were used to predict disease progression by Cox regression and area under the receiver operating characteristic curves. The endpoints assessed were 30-day all-cause mortality, intubation and ventilation, critical care admission and non-invasive ventilation (NIV) use.ResultsElevated MR-proADM was shown to have the greatest ability to predict 30-day mortality adjusting for age, cardiovascular disease, renal disease and neurological disease. A significant association was also noted between raised MR-proADM and CRP concentrations and the requirement for critical care admission and NIV.ConclusionsThe measurement of MR-proADM and CRP in patients with confirmed COVID-19 infection on admission shows significant potential to support clinicians in identifying those at increased risk of disease progression and need for higher level care, subsequently enabling prompt escalation in clinical interventions.

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C-Reactive Protein to Albumin Ratio Predicts Survival in Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib: A Multicenter Analysis

10.21203/rs.3.rs-1034239/v1 ◽

2021 ◽

Author(s):

Toshifumi Tada ◽

Takashi Kumada ◽

Atsushi Hiraoka ◽

Masashi Hirooka ◽

Kazuya Kariyama ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Multivariate Analysis ◽

Progression Free Survival ◽

C Reactive Protein ◽

Free Survival ◽

Albumin Ratio ◽

Cutoff Value ◽

Reactive Protein ◽

Unresectable Hepatocellular Carcinoma

Abstract We investigated the impact of C-reactive protein to albumin ratio (CAR) on predicting outcomes in 522 patients with unresectable hepatocellular carcinoma (HCC) treated with lenvatinib. We determined the optimal CAR cutoff value with time-dependent receiver operating characteristic curve analysis. Additionally, we clarified the relationship between CAR and liver function or HCC progression. Median overall survival was 20.0 (95% confidence interval (CI), 17.2–22.6) months. The optimal CAR cutoff value was determined to be 0.108. Multivariate analysis showed that high CAR (≥0.108) (hazard ratio (HR), 1.915; 95% CI, 1.495–2.452), Eastern Cooperative Oncology Group performance status ≥1 (HR, 1.429), and α-fetoprotein ≥400 ng/mL (HR, 1.604) were independently associated with overall survival. Cumulative overall survival differed significantly between patients with low versus high CAR (p<0.001). Median progression-free survival was 7.5 (95% CI, 6.7–8.1) months. Multivariate analysis showed that age, CAR ≥0.108 (HR, 1.644; 95% CI, 1.324–2.043), and non-hepatitis B, non-hepatitis C etiology (HR, 0.726) were independently associated with progression-free survival. Cumulative progression-free survival differed significantly between patients with low versus high CAR (p<0.001). CAR values were significantly higher as Japan Integrated Staging score increased (p<0.001). In conclusion, CAR can predict outcomes in patients with unresectable HCC treated with lenvatinib.

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FIGO 2018 stage IB endocervical adenocarcinomas: an international study of outcomes informed by prognostic biomarkers

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001893 ◽

2020 ◽

pp. ijgc-2020-001893

Author(s):

Simona Stolnicu ◽

Monica Boros ◽

Lien Hoang ◽

Noorah Almadani ◽

Louise de Brot ◽

...

Keyword(s):

Overall Survival ◽

Lymph Node ◽

Lymphovascular Invasion ◽

Figo Stage ◽

Prognostic Biomarkers ◽

Recurrence Free Survival ◽

Free Survival ◽

Stage Ib ◽

Gynecology And Obstetrics ◽

Hpv Status

ObjectivePrognostic factors for endocervical adernocarcinomas are well known, but little is known about prognostic biomarkers influencing outcome for the newly defined International Federation of Gynecology and Obstetrics (FIGO) 2018 IB sub-stages. The aim of this study was to identify prognostic biomarkers influencing recurrence-free and overall survival for FIGO 2018 stage IB cervical adenocarcinoma sub-types. We sought to identify these factors using a large international multi-institutional series of cases.MethodsStage IB endocervical adenocarcinomas were retrospectively collected from nine international institutions; full slide sets (n=464) were used to assign prognostic biomarkers. Inclusion criteria were the following: FIGO stage IB endocervical adenocarcinomas with follow-up in which all paraffin blocks/glass slides were available for review and/or additional studies and the patient was surgically treated from 1985 to 2019. The types of specimens included in the study were conizations, trachelectomies, and simple/radical hysterectomies with or without lymph node samples. We excluded in situ carcinomas, squamous cell carcinomas, adenosquamous carcinomas, tumors with a neuroendocrine component, carcinosarcomas, and any tumor showing clinical, macroscopic, or microscopic features suggesting a lower uterine segment, uterine corpus, or an adnexal primary origin. Tumors treated with neoadjuvant chemotherapy and/or radiation therapy were also excluded, as well as biopsies and loop electrosurgical excision procedures.ResultsOf 464 cases, 225 (48%) were stage IB1, 177 (38%) were stage IB2, and 62 (13%) were stage IB3. Five-year and 10-year recurrence-free survivals were statistically different among stage IB sub-types (p=0.005). Silva pattern of invasion was significant for recurrence-free survival at 5 and 10 years (p=0.04); overall survival and recurrence-free survival were higher in human papillomavirus (HPV)-associated cases (p=0.007 and p=0.001, respectively) and in cases without lymphovascular invasion (p=0.004 and p=0.00001, respectively). Factors that significantly influenced recurrence-free survival were HPV-independent status (p=0.05; HR 2.31; 95% CI 1.02 to 5.46), presence of lymphovascular invasion (p=0.011; HR 3.50; 95% CI 1.33 to 9.19), and presence of lymph node metastasis (p=0.016; HR 2.66; 95% CI 1.20 to 5.90).ConclusionHPV status and the presence of lymphovascular invasion are prognosticators in stage IB endocervical adenocarcinoma sub-types. These parameters should be included in future sub-staging modifications of FIGO stage IB endocervical adenocarcinomas and in treatment strategies.

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C-Reactive Protein to Prealbumin Ratio (CPR): A Novel Inflammatory-Nutritional Prognostic Factor for Predicting Cancer-Specific Survival (CSS) and Overall Survival (OS) in Patients with Resectable Esophageal Squamous Cell Carcinoma

Journal of Oncology ◽

10.1155/2019/4359103 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 2

Author(s):

Ji-Feng Feng ◽

Liang Wang ◽

You-Hua Jiang ◽

Xun Yang

Keyword(s):

Overall Survival ◽

Squamous Cell Carcinoma ◽

Esophageal Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Cox Regression ◽

C Reactive Protein ◽

Cancer Specific Survival ◽

Reactive Protein ◽

Resectable Esophageal

Background. The inflammation and nutrition play an important role in prognosis. A novel index combined with inflammatory and nutritional biomarkers, named C-reactive protein (CRP) to prealbumin (PALB) ratio (CPR), was initially reported to predict the prognosis in resectable esophageal squamous cell carcinoma (ESCC). Patients and Methods. A retrospective study was conducted including 346 resectable ESCC patients. The X-tile program was used to confirm the optimal cut-off value. The Kaplan-Meier methods and Cox regression analyses were performed to analyze the cancer-specific survival (CSS) and overall survival (OS). Results. The optimum cut-off point was 0.03 for CPR. Patients with a high level of CPR (> 0.03) were associated with poor CSS (12.0% vs. 43.0%, P<0.001) and OS (11.2% vs. 40.7%, P<0.001). Multivariate analyses revealed that CPR was an independent predictor in resectable ESCC patients (CSS, P=0.008; OS, P=0.007). Conclusion. This study, to the best of our knowledge, is the first to investigate prognostic role of CPR in patients with ESCC. Our retrospective observations indicate that CPR, with the optimal cut-off value of 0.03, is a useful potential predictor in resectable ESCC patients.

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Novel Gene Signatures Predictive of Patient Recurrence-Free Survival and Castration Resistance in Prostate Cancer

Cancers ◽

10.3390/cancers13040917 ◽

2021 ◽

Vol 13 (4) ◽

pp. 917

Author(s):

Jun A ◽

Baotong Zhang ◽

Zhiqian Zhang ◽

Hailiang Hu ◽

Jin-Tang Dong

Keyword(s):

Prostate Cancer ◽

Cox Regression ◽

Characteristic Curve ◽

Treatment Decision ◽

Rank Aggregation ◽

Lymph Node Status ◽

Calibration Plot ◽

Recurrence Free Survival ◽

Castration Resistance ◽

Free Survival

Molecular signatures predictive of recurrence-free survival (RFS) and castration resistance are critical for treatment decision-making in prostate cancer (PCa), but the robustness of current signatures is limited. Here, we applied the Robust Rank Aggregation (RRA) method to PCa transcriptome profiles and identified 287 genes differentially expressed between localized castration-resistant PCa (CRPC) and hormone-sensitive PCa (HSPC). Least absolute shrinkage and selection operator (LASSO) and stepwise Cox regression analyses of the 287 genes developed a 6-gene signature predictive of RFS in PCa. This signature included NPEPL1, VWF, LMO7, ALDH2, NUAK1, and TPT1, and was named CRPC-derived prognosis signature (CRPCPS). Interestingly, three of these 6 genes constituted another signature capable of distinguishing CRPC from HSPC. The CRPCPS predicted RFS in 5/9 cohorts in the multivariate analysis and remained valid in patients stratified by tumor stage, Gleason score, and lymph node status. The signature also predicted overall survival and metastasis-free survival. The signature’s robustness was demonstrated by the C-index (0.55–0.74) and the calibration plot in all nine cohorts and the 3-, 5-, and 8-year area under the receiver operating characteristic curve (0.67–0.77) in three cohorts. The nomogram analyses demonstrated CRPCPS’ clinical applicability. The CRPCPS thus appears useful for RFS prediction in PCa.

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Postoperative non-steroidal anti-inflammatory drug use and oncological outcomes of rectal cancer

BJS Open ◽

10.1093/bjsopen/zraa050 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

O Grahn ◽

M Lundin ◽

M-L Lydrup ◽

E Angenete ◽

M Rutegård

Keyword(s):

Rectal Cancer ◽

Propensity Score ◽

Propensity Score Matching ◽

Instrumental Variables ◽

Cox Regression ◽

Recurrence Free Survival ◽

Free Survival ◽

Oncological Outcomes ◽

Anti Inflammatory ◽

Instrumental Variables Approach

Abstract Background Non-steroidal anti-inflammatory drugs (NSAIDs) are known to suppress the inflammatory response after surgery and are often used for pain control. This study aimed to investigate NSAID use after radical surgical resection for rectal cancer and long-term oncological outcomes. Methods A cohort of patients who underwent anterior resection for rectal cancer between 2007 and 2013 in 15 hospitals in Sweden was investigated retrospectively. Data were obtained from the Swedish Colorectal Cancer Registry and medical records; follow-up was undertaken until July 2019. Patients who received NSAID treatment for at least 2 days after surgery were compared with controls who did not, and the primary outcome was recurrence-free survival. Cox regression modelling with confounder adjustment, propensity score matching, and an instrumental variables approach were used; missing data were handled by multiple imputation. Results The cohort included 1341 patients, 362 (27.0 per cent) of whom received NSAIDs after operation. In analyses using conventional regression and propensity score matching, there was no significant association between postoperative NSAID use and recurrence-free survival (adjusted hazard ratio (HR) 1.02, 0.79 to 1.33). The instrumental variables approach, including individual hospital as the instrumental variable and clinicopathological variables as co-variables, suggested a potential improvement in the NSAID group (HR 0.61, 0.38 to 0.99). Conclusion Conventional modelling did not demonstrate an association between postoperative NSAID use and recurrence-free survival in patients with rectal cancer, although an instrumental variables approach suggested a potential benefit.

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A High C-Reactive Protein Level on Postoperative Day 7 is Associated with Poor Survival of Patients with Pancreatic Ductal Adenocarcinoma after Resection

The American Surgeon ◽

10.1177/00031348211023406 ◽

2021 ◽

pp. 000313482110234

Author(s):

Masaji Tani ◽

Hiroya Iida ◽

Hiromitsu Maehira ◽

Haruki Mori ◽

Toru Miyake ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Pancreatic Ductal Adenocarcinoma ◽

Median Overall Survival ◽

Cox Regression ◽

Ductal Adenocarcinoma ◽

C Reactive Protein ◽

Reactive Protein ◽

Retrospective View ◽

Node Metastases ◽

Common Malignancy

Introduction Pancreatic ductal adenocarcinoma (PDAC) is a common malignancy. While inflammation-related biomarkers influence patient survival after resection, it has not been known whether postoperative inflammations affect the survival of PDAC patients or not. Methods It was investigated whether the universal biomarkers on postoperative day (POD) 7 affect the survival of PDAC patients in the retrospective view, and univariate and multivariate analyses were performed via the Cox regression method. Results Overall, 108 consecutive patients underwent resection; 98 (90.7%) had T3 disease and 73 (67.6%) had lymph node metastases. Thirty-four patients (31.5%) experienced postoperative complications. Compared with preoperative values, the white blood cell count and C-reactive protein (CRP) level on POD 7 were significantly elevated ( P < .001 for both); conversely, the lymphocyte count was significantly reduced ( P < .001). Among 108 patients, 72 received adjuvant chemotherapy. The median overall survival was 21.0 months; the 5-year survival rate was 22.3%. On multivariate analysis, receiving adjuvant chemotherapy and low CRP levels on POD 7 (<7.6 mg/dL) were prognosticators of better survival. However, the CD classification was not a prognosticator of survival after resection. Conclusions Adjuvant chemotherapy and postoperative low CRP levels on POD 7 were prognosticators of better survival of PDAC patients after resection. Surgeons should be aware of managing postoperative infections because a high postoperative CRP level is related with unfavorable survival.

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Epigenetic Alterations Associated with the Overall Survival and Recurrence Free Survival among Oral Squamous Cell Carcinoma Patients

Journal of Clinical Medicine ◽

10.3390/jcm9041035 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1035 ◽

Cited By ~ 1

Author(s):

Yasmen Ghantous ◽

Aysar Nashef ◽

Imad Abu-Elnaaj

Keyword(s):

Overall Survival ◽

Squamous Cell Carcinoma ◽

Oral Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Clinical Features ◽

Squamous Cell ◽

Methylation Status ◽

Recurrence Free Survival ◽

Epigenetic Alterations ◽

Free Survival

Oral squamous cell carcinoma (OSCC) is a fatal disease caused by complex interactions between environmental, genomic, and epigenetic alterations. In the current study, we aimed to identify clusters of genes whose promoter methylation status correlated with various tested clinical features. Molecular datasets of genetic and methylation analysis based on whole-genome sequencing of 159 OSCC patients were obtained from the The Cancer Genome Atlas (TCGA) data portal. Genes were clustered based on their methylation status and were tested for their association with demographic, pathological, and clinical features of the patients. Overall, seven clusters of genes were revealed that showed a significant association with the overall survival/recurrence free survival of patients. The top ranked genes within cluster 4, which showed the worst prognosis, primarily acted as paraneoplastic genes, while the genes within cluster 6 primarily acted as anti-tumor genes. A significant difference was found regarding the mean age in the different clusters. No significant correlation was found between the tumor staging and the different clusters. In conclusion, our result provided a proof-of-principle for the existence of phenotypic diversity among the epigenetic clusters of OSCC and demonstrated the utility of the use epigenetics alterations in devolving new prognostic and therapeutics tools for OSCC patients.

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C-Reactive Protein and All-Cause Mortality in a Large Hospital-Based Cohort

Clinical Chemistry ◽

10.1373/clinchem.2007.091959 ◽

2008 ◽

Vol 54 (2) ◽

pp. 343-349 ◽

Cited By ~ 62

Author(s):

Claudia Marsik ◽

Lili Kazemi-Shirazi ◽

Thomas Schickbauer ◽

Stefan Winkler ◽

Christian Joukhadar ◽

...

Keyword(s):

Hospital Admission ◽

Acute Phase ◽

Cox Regression ◽

Disease Risk ◽

C Reactive Protein ◽

Reactive Protein ◽

Increased Risk ◽

All Cause Mortality ◽

Low Sensitivity

Abstract Background: C-reactive protein (CRP), an acute-phase protein, is a sensitive systemic marker of inflammation and acute-phase reactions. Testing CRP concentrations at hospital admission may provide information about disease risk and overall survival. Methods: All first-ever transmittals to the department of medical and chemical laboratory diagnostics for determination of low-sensitivity CRP (n = 274 515, 44.5% male, median age 51 years) between January 1991 and July 2003 were included [median follow-up time: 4.4 years (interquartile range, 2.3–7.4 years)]. The primary endpoint was all-cause mortality. Multivariate Cox regression adjusted for sex and age was applied for analysis. Results: Compared to individuals within the reference category (CRP <5 mg/L), hazard ratios (HR) for all-cause mortality increased from 1.4 (5–10 mg/L category) to 3.3 in the highest category (>80 mg/L, all P <0.001). CRP was associated with various causes of death. The relation of CRP to cancer death was stronger than to vascular death. Younger patients with increased CRP had relatively far worse outcome than older patients (maximal HR: ≤30 years: 6.7 vs >60 years: 1.7–3.7). Interestingly, both short- and long-term mortality were associated with increasing CRP concentrations (>80 mg/L: HR 22.8 vs 1.4). Conclusion: Measurement of low-sensitivity CRP at hospital admission allowed for the identification of patients at increased risk of unfavorable outcome. Our findings indicate that close attention should be paid to hospitalized patients with high CRP not only because of very substantial short-term risk, but also long-term excess risk, the basis for which needs to be determined.

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