Fujiwara Hitoshi, Shiozaki Atsushi, Furutani Akinobu, Yoneda Masayuki, Kubota Takeshi, Komatsu Shuhei, Ichikawa Daisuke, Okamoto Kazuma, Murayama Yasutoshi, Kuriu Yoshiaki, Ikoma Hisashi, Nakanishi Masayoshi, Ochiai Toshiya, Otsuji Eigo
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.
Mol Clin Oncol. 2013 May;1(3):558-564. doi: 10.3892/mco.2013.84. Epub 2013 Mar 5.
Preoperative serum C-reactive protein (CRP) levels have been shown to be of prognostic significance in patients with advanced esophageal carcinoma. However, the clinical significance of serum CRP levels in patients with unresectable or marginally resectable tumors in the absence of induction therapy has not been fully elucidated in relation to treatment response and prognosis. Thirty-four patients with clinical T3-T4 esophageal squamous cell carcinoma who underwent induction chemoradiotherapy (CRT) followed by esophagectomy were enrolled in this retrospective study. Serum CRP levels were measured during the course of CRT, i.e., prior to, during (1, 2, 3 and 4 weeks following initiation) and after CRT (prior to surgery). The association between CRP levels, CRT response and survival was analyzed. Elevated serum CRP levels exhibited a favorable decrease 2-3 weeks following CRT initiation in pathological responders and CRP ≤0.3 mg/dl at 2 and 3 weeks following CRT initiation, as well as prior to surgery, was significantly correlated with responders. In patients with pretreatment CRP >0.3 mg/dl (67.6% of patients in this study), CRP ≤0.3 mg/dl at 2 and 3 weeks following CRT initiation predicted responders with accuracies of 87.0 and 73.9%, respectively. In the univariate survival analysis, CRP levels 3 weeks following CRT initiation, as well as CRP levels prior to surgery and pathological stage, were significant prognostic factors, although CRP levels prior to surgery was the only independent prognostic factor in the multivariate analysis. Serum CRP levels during the course of CRT may be of prognostic and predictive significance for the CRT response in patients with unresectable or marginally resectable esophageal squamous cell carcinoma who undergo induction CRT.
术前血清C反应蛋白（CRP）水平已被证明在晚期食管癌患者中具有预后意义。然而，在未接受诱导治疗的不可切除或勉强可切除肿瘤患者中，血清CRP水平与治疗反应和预后相关的临床意义尚未完全阐明。本回顾性研究纳入了34例临床T3 - T4期食管鳞状细胞癌患者，这些患者先接受诱导放化疗（CRT），然后进行食管切除术。在CRT过程中，即CRT之前、期间（开始后1、2、3和4周）以及CRT之后（手术前）测量血清CRP水平。分析了CRP水平、CRT反应与生存之间的关联。病理反应者在CRT开始后2 - 3周血清CRP水平呈现出有利的下降，且在CRT开始后2周和3周以及手术前CRP≤0.3mg/dl与反应者显著相关。在预处理CRP>0.3mg/dl的患者中（本研究中占67.6%），CRT开始后2周和3周CRP≤0.3mg/dl预测反应者的准确率分别为87.0%和73.9%。在单因素生存分析中，CRT开始后3周的CRP水平、手术前的CRP水平以及病理分期是显著的预后因素，尽管在多因素分析中手术前的CRP水平是唯一的独立预后因素。对于接受诱导CRT的不可切除或勉强可切除食管鳞状细胞癌患者，CRT过程中的血清CRP水平可能对CRT反应具有预后和预测意义。
