C-Reactive Protein Level Predicts Survival Outcomes in Rectal Cancer Patients Undergoing Total Mesorectal Excision After Preoperative Chemoradiation Therapy

• Published in: Annals of surgical oncology Vol. 25; no. 13; pp. 3898 - 3905
• Main Authors: Kim, Woo Ram, Han, Yoon Dae, Min, Byung Soh
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2018; Springer Nature B.V
• Subjects: Adenocarcinoma - blood; Adenocarcinoma - secondary; Adenocarcinoma - therapy; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Body Mass Index; C-reactive protein; C-Reactive Protein - metabolism; Cancer; Capecitabine - administration & dosage; Chemoradiotherapy; Chemoradiotherapy, Adjuvant; Chemotherapy; Colorectal Cancer; Digestive System Surgical Procedures; Disease-Free Survival; Female; Fluorouracil - administration & dosage; Follow-Up Studies; Health risk assessment; Humans; Inflammation; Leucovorin - administration & dosage; Lymphatic Metastasis; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Neoadjuvant Therapy; Neoplasm Grading; Neoplasm Staging; Oncology; Preoperative Period; Radiation therapy; Radiotherapy Dosage; Rectal Neoplasms - blood; Rectal Neoplasms - pathology; Rectal Neoplasms - therapy; Rectum; Surgery; Surgical Oncology; Survival; Survival Rate; Total Mesorectal Excision (TME); Cancer-specific Survival (CSS); Rectal Cancer Patients; Potential Predictive Marker; Preoperative Chemoradiation Therapy
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-018-6828-4

Background Systemic inflammatory response, as measured by C-reactive protein (CRP), is associated with prognosis in various types of human malignancies. However, to the best of our knowledge, the clinical significance of CRP in patients with locally advanced rectal cancer that undergo preoperative chemoradiation has not been investigated in detail. This retrospective study validates CRP as a potential predictive marker for survival outcomes in rectal cancer patients. Methods In this study, we enrolled 125 patients that received total mesorectal excision after preoperative chemoradiation for rectal cancer between January 2003 and December 2010. We investigated the association between preoperative CRP and clinicopathological characteristics and assessed the prognostic value of CRP. Results The median follow-up was 41 months. Elevated CRP showed significant correlation with high histological grade ( P  = 0.009) and cancer recurrence ( P  = 0.027). The 5-year disease-free survival and cancer-specific survival were significantly lower in the elevated CRP group ( P  = 0.001). Moreover, CRP was the strongest predictive factor for cancer-specific survival in multivariate analysis ( P  = 0.001). In the subgroup analysis, elevated CRP was a significant prognostic factor in patients with node-positive disease ( P  = 0.025) and was associated with poorer tumor regression (TRG4–5; P  = 0.011). Conclusions The results of our study suggest that preoperative CRP level shows prognostic significance in rectal cancer patients that have undergone chemoradiation. Therefore, preoperative CRP may help clinicians to identify patients that need additional therapy to reduce systemic failure.