C反应蛋白是结直肠癌的一个预后因素吗？

Is C-reactive protein a prognostic factor of colorectal cancer?

作者信息

Shiu Yu-Chen, Lin Jen-Kou, Huang Chi-Jung, Jiang Jeng-Kai, Wang Ling-Wei, Huang Huei-Chen, Yang Shung-Haur

机构信息

Division of Colon and Rectal Surgery, Department of Surgery, Taipei-Veterans General Hospital, No 201, Sec 2, Shih-Pai Rd, 11217 Taipei, Taiwan.

出版信息

Dis Colon Rectum. 2008 Apr;51(4):443-9. doi: 10.1007/s10350-007-9133-z. Epub 2008 Jan 3.

DOI:10.1007/s10350-007-9133-z

PMID:18172726

Abstract

PURPOSE

C-reactive protein, a commonly used inflammation marker, has been reported to be a prognostic factor of colorectal cancer. This prospective study was designed to confirm the prognostic value of its preoperative levels and to observe their perioperative change.

METHODS

Between January 2001 and September 2005, preoperative C-reactive protein levels were obtained for 212 consecutive patients (140 males) receiving elective open resection of colorectal cancer. A level higher than 0.5 mg/dl was defined as positive. They were analyzed against clinicopathologic factors. The survival of 158 curative resections was analyzed. Postoperative levels (at months 1, 3, and 6) were collected for analysis of changing trend, from the patients receiving curative surgeries.

RESULTS

Median value of preoperative C-reactive protein was 0.54 mg/dl (48.6 percent positive). Positive rate was significantly correlated with ulcerative type, larger size, higher stage, and positive carcinoembryonic antigen (>5 ng/ml). In both univariate log-rank test and multiple Cox proportional hazards regression, stage (univariate P = 0.011, and multivariate P = 0.016; hazard ratio, 6.23; 95 percent confidence interval, 1.41-27.54), C-reactive protein (0.5 mg/dl; P = 0.005, and P = 0.016; hazard ratio: 6.51; 95 percent confidence interval: 1.41-30.05), and differentiation (P = 0.006, and P = 0.043; hazard ratio, 3.53; 95 percent confidence interval, 1.04-11.98) were significant factors. Analysis of disease-free interval showed C-reactive protein was significant (P = 0.03): as level rose, prognosis worsened. The quiescent inflammation-response group (< or =0.1 mg/dl) had excellent outcomes. Postoperatively, the C-reactive protein levels declined at the third postoperative month.

CONCLUSIONS

Preoperative C-reactive protein is an independent prognostic factor. The levels declined postoperatively, although with a lag. These findings seem to support the response hypothesis regarding C-reactive protein.

摘要

目的

C反应蛋白是一种常用的炎症标志物，据报道是结直肠癌的预后因素。本前瞻性研究旨在证实其术前水平的预后价值并观察其围手术期变化。

方法

在2001年1月至2005年9月期间，对212例连续接受择期开放性结直肠癌切除术的患者（140例男性）测定术前C反应蛋白水平。高于0.5mg/dl的水平定义为阳性。将其与临床病理因素进行分析。对158例根治性切除术患者的生存情况进行分析。收集接受根治性手术患者术后（第1、3和6个月）的水平以分析变化趋势。

结果

术前C反应蛋白的中位数为0.54mg/dl（48.6%为阳性）。阳性率与溃疡型、较大尺寸、较高分期及癌胚抗原阳性（>5ng/ml）显著相关。在单因素对数秩检验和多因素Cox比例风险回归中，分期（单因素P = 0.011，多因素P = 0.016；风险比，6.23；95%置信区间，1.41 - 27.54）、C反应蛋白（>0.5mg/dl；P = 0.005，P = 0.016；风险比：6.51；95%置信区间：1.41 - 30.05）及分化程度（P = 0.006，P = 0.043；风险比，3.53；95%置信区间，1.04 - 11.98）均为显著因素。无病间期分析显示C反应蛋白具有显著性（P = 0.03）：随着水平升高，预后恶化。静息炎症反应组（≤0.1mg/dl）预后良好。术后，C反应蛋白水平在术后第三个月下降。