Prognostic role of C-reactive protein levels in patients with hepatocellular carcinoma undergoing sorafenib therapy.

340 Background: Markers of systemic inflammatory response including C-reactive protein (CRP) are associated with the prognosis of various malignancies including HCC. We investigated the significance of the serum CRP level as a prognostic factor in patients with advanced HCC on sorafenib therapy. Methods: The MSKCC institutional database was retrospectively queried for patients diagnosed with advanced HCC who received sorafenib therapy from 2002-2012 and had available serum CRP measurements. Patient demographics and outcomes were extracted under an IRB-approved waiver. Baseline CRP levels within 30 days of starting of sorafenib and while on sorafenib treatment were correlated with clinical outcomes. CRP levels after the initiation of sorafenib were analyzed as a time dependent covariate in a Cox regression model. Results: 51 patients had available CRP levels and received sorafenib: Median age 65 years (range 45-82); KPS 80 (70-90%); 9 females (17.6%); 32 AJCC stage IV disease (62.7%); 10 AJCC stage III (19.6%); 12 hepatitis C (23.5%), 10 hepatitis B (19.6%), 12 alcohol (23.5%), and 20 non-alcoholic steatohepatitis (39%); and 43 Child-Pugh A (84.3 %). The median time on sorafenib was 2.4 months (range 0.2-21.6). The median overall survival (OS) was 9.2 months [CI 5.8 – 13.6] and the median progression-free survival (PFS) was 2.1 months [CI 1.6 – 2.6]. 46 of 51 patients had baseline CRP levels available for analysis. Baseline CRP level was associated with OS [hazard ratio (HR) 1.2 (CI 0.996 – 1.4, p=0.056)] but not with PFS [HR 1.1 (CI 0.96-1.3, p=0.14)]. Time dependent covariate analysis demonstrated an association between CRP levels during sorafenib therapy and overall OS [HR 1.08 (CI 1.01-1.16, p=0.02)] as well as PFS [HR 1.09 (CI 1.02 – 1.16, p=0.009)]. Conclusions: Baseline CRP level prior to the start of sorafenib therapy showed a borderline significant association with OS but no association with PFS. Higher CRP levels showed a significant association with increased risk of disease progression and death for sorafenib treated HCC patients. Potential prognostic role of CRP in HCC patients undergoing sorafenib therapy is to be further studied prospectively.

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Prognostic role of the pretreatment C-reactive protein/albumin ratio in gastric cancer

Medicine ◽

10.1097/md.0000000000019362 ◽

2020 ◽

Vol 99 (10) ◽

pp. e19362

Author(s):

Xuanxuan Yang ◽

Xing Song ◽

Luo Zhang ◽

Changping Wu

Keyword(s):

Gastric Cancer ◽

C Reactive Protein ◽

Prognostic Role ◽

Albumin Ratio ◽

Reactive Protein

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Prognostic Value of Serum Ferritin, Transferrin Saturation and C- Reactive Protein At Diagnosis In Myelodysplastic Syndrome Patients: Analysis of Patients From the MDS Piedmont Registry,

Blood ◽

10.1182/blood.v118.21.3807.3807 ◽

2011 ◽

Vol 118 (21) ◽

pp. 3807-3807 ◽

Cited By ~ 1

Author(s):

Emanuela Messa ◽

Daniela Gioia ◽

Claudia Bertassello ◽

Gianni Ciccone ◽

Andrea Evangelista ◽

...

Keyword(s):

Oxidative Stress ◽

Myelodysplastic Syndrome ◽

Negative Impact ◽

Transferrin Saturation ◽

C Reactive Protein ◽

Prognostic Role ◽

Normal Range ◽

Reactive Protein ◽

Iron Parameters

Abstract Abstract 3807 Background: The prognostic role of serum ferritin (SF) evaluation at baseline in patients (pts) affected by myelodysplastic syndrome (MDS) is still controversial. In fact, increased SF mainly due to transfusion requirement during disease history has a clear negative impact on overall survival (OS) (Malcovati et al., 2006) and also on leukemic evolution (LE) (Sanz, ASH 2008, de Swart ASH 2010) while contrasting data about its role at baseline on OS has been published. Park and colleagues (ASH 2010) failed to identify a negative prognostic impact of SF higher than 300 ng/mL in a cohort of low risk untransfused MDS patients while data from the European LeukemiaNet MDS registry identified SF as an independent prognostic factor for OS and progression-free survival in low- and int-1 MDS (de Swart, Edimburgh 2011). SF can be a marker of iron overload but also of inflammation and little is known about the impact on survival of other iron parameters such as transferrin saturation (TS) or inflammation such as C reactive protein (CRP) in MDS pts at diagnosis. Aim: Aim of our study was to evaluate the prognostic role of iron parameters and inflammation at diagnosis in MDS patients analyzing data collected in the MDS Piedmont Registry. Materials and methods: 1360 patients enrolled in the MDS Piedmont Registry (1999–2010) were analyzed. Patients with information on OS and LE and available baseline SF (n=670), TS (n=299), CRP (n=287) were included in the analysis. Survival analysis was performed using Kaplan-Meier method. Patients were stratified according to a cut off value of 800 ng/mL for SF, 40% for TS and values within or higher the normal range (0,8 mg/dL) for CRP. In order to compare survival curves, log-rank test was used. Cumulative incidence of LE, according to SF, TS and CRP levels, was calculated accounting for death from any causes as a competing event. Results: In the population with SF baseline values, 3-years OS in pts with SF < 800 ng/mL was 80.7 (95%CI: 75.8–84.8) and in pts with SF >800 ng/mL was 66.1 (95%CI: 46.7–79.8) (p= 0,006). The result seems to be confirmed in the low risk MDS subgroup in toto (n=226) and considering only the untransfused pts (136 cases) (p=0,0073 and p=0,0038 respectively) but no statistically significance in OS of high risk pts (n=108) has been observed. In subjects with available data on TS, 3-years OS for pts with TS lower than 40% was 75.0 (95% CI: 64.2–83.0) while in pts higher than 40% was 72.1 (95%CI: 59.5–81.4) (p=0,1). Finally, in pts with CRP values 3-years OS was 80.8 (95%CI: 69.7–88.2) for patients < 0,8 mg/dL and 47.2 (95%CI: 34.5–58.9) for pts > 0,8 mg/dL. Also 3-year cumulative incidence of LE was higher in pts with SF > 800 ng/mL [35.8 (95%CI: 20.3–51.2) vs 18.5 (95%CI: 14.4–22.5); p=0,002 ] and in those with CPR > 0,8 mg/dL [35.3 (95%CI: 23.9–46.7) vs 12.7 (95%CI: 5.7–19.7); p<0,001]. In TS subgroups no difference was observed [13.5 (95%CI: 7.0–20.0) for TS<40% vs 20.8 (95%CI: 11.8–29.8) for TS>40%; p=0.172]. Conclusions: although the limits of missing data, our results suggest that high levels of SF and CRP above the normal range at baseline should have a prognostic role in MDS pts, while TS seems to have little impact on OS. Moreover SF and CRP seem to have both a negative impact on LE. Our data suggest a more important prognostic role of chronic inflammation parameters than iron overload or oxidative stress in MDS patients at diagnosis. Further prospective evaluation of more specific parameter of oxidative stress and inflammation need to be analyzed in order to confirm our preliminary observation. Disclosures: No relevant conflicts of interest to declare.

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