Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Cancer Med. 2021 Jan;10(1):34-44. doi: 10.1002/cam4.3514. Epub 2020 Dec 3.
Perioperative C-reactive protein (CRP) levels have effects on the prognosis of cancer patients. We intended to determine the prognostic value of combining the two for gastric cancer (GC).
Data were extracted from a clinical trial. By calculating the area under the curve (AUC) and the C-index, the predictive value of CRPs among different time points, including preoperative (pre-CRP), postoperative days 1, 3, and 5 (post-CRPs), and postoperative maximum CRP (post-CRP ), was derived. Multivariate analysis was performed to further explore the independent variates for recurrence-free survival (RFS).
Finally, 401 patients were available in the present study. For RFS, higher AUC (0.692) and concordance index (0.678) of pre-CRP were observed when compared with those of post-CRPs. Further, among post-CRPs, post-CRP had the highest predictive values (AUC: 0.591; concordance index: 0.585) among the other post-CRPs. The threshold values in predicting RFS for pre-CRP and post-CRP were 3.1 mg/L and 77.1 mg/L. Multivariate analysis showed both pre-CRP≥3.1 mg/L (high-pre-CRP) and post-CRP ≥77.1 mg/L (high-post-CRP ) were risk factors for RFS. Postoperative chemotherapy benefit was further analyzed for patients with stage II/III GC and indicated that patients with pre-CRP<3.1 mg/L had better prognosis without benefit from postoperative adjuvant chemotherapy (ACT), p = 0.557. In high-pre-CRP patients, only patients with post-CRP ≥77.1 mg/L but not post-CRP <77.1 mg/L benefited from postoperative ACT (RFS: 33.2% vs 49.9% for non-chemotherapy group and chemotherapy group, respectively, p = 0.037). Analyses for overall survival obtained the similar outcomes.
Both high-pre-CRP and high-post-CRP are associated with worse prognosis in GC. ACT seems to only improve the prognosis for stage II/III GC with pre-CRP≥3.1 mg/L and post-CRP ≥77.1 mg/L after radical gastrectomy. Further studies are needed to confirm these findings and explore the potential mechanism.
围手术期 C 反应蛋白 (CRP) 水平对癌症患者的预后有影响。我们旨在确定联合检测 CRP 对胃癌 (GC) 的预后价值。
数据来自一项临床试验。通过计算曲线下面积 (AUC) 和 C 指数，得出术前 (pre-CRP)、术后第 1、3 和 5 天 (post-CRPs) 和术后最大 CRP (post-CRP ) 等不同时间点 CRP 的预测价值。进行多变量分析以进一步探讨无复发生存率 (RFS) 的独立变量。
本研究最终纳入 401 例患者。对于 RFS，pre-CRP 的 AUC（0.692）和一致性指数（0.678）均高于 post-CRPs。此外，在 post-CRPs 中，post-CRP 的预测价值最高（AUC：0.591；一致性指数：0.585）。pre-CRP 和 post-CRP 预测 RFS 的截断值分别为 3.1mg/L 和 77.1mg/L。多变量分析表明，pre-CRP≥3.1mg/L（高 pre-CRP）和 post-CRP≥77.1mg/L（高 post-CRP）均是 RFS 的危险因素。进一步对 II/III 期 GC 患者进行术后化疗获益分析，结果表明，pre-CRP<3.1mg/L 的患者无术后辅助化疗（ACT）获益，预后较好（p=0.557）。在高 pre-CRP 患者中，仅 post-CRP≥77.1mg/L 的患者受益于术后 ACT（RFS：非化疗组和化疗组分别为 33.2%和 49.9%，p=0.037）。总体生存分析得出了类似的结果。
高 pre-CRP 和高 post-CRP 均与 GC 的预后不良相关。ACT 似乎仅能改善根治性胃切除术后 pre-CRP≥3.1mg/L 和 post-CRP≥77.1mg/L 的 II/III 期 GC 患者的预后。需要进一步的研究来证实这些发现并探讨潜在的机制。
