Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.
Department of Physiotherapy and Occupational Therapy, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.
Crit Rev Clin Lab Sci. 2022 Nov;59(7):480-500. doi: 10.1080/10408363.2022.2050886. Epub 2022 Apr 9.
Inflammation is an enabling characteristic of the hallmarks of cancer. There has therefore been increasing interest in the clinical value of circulating inflammatory biomarkers in cancer. In this review, we summarize results on C-reactive protein (CRP), alone or as part of the Glasgow Prognostic Score (GPS, composed of CRP and serum albumin), as a biomarker of prognosis or prediction and monitoring of therapeutic response in patients with breast cancer. A systematic literature search was performed in Medline and Embase from 1990 to August 2021. The association of serum CRP and overall survival and disease/progression-free survival was summarized in meta-analyses using a random effects model. The results from a total of 35 included studies (20,936 patients) were divided according to three identified patient settings (metastatic, non-metastatic, and general setting). Most of the studies examined prognostic utility. Several larger studies observed associations between high serum CRP and poor survival, but the meta-analyses suggested a limited value in a non-metastatic and general breast cancer setting (populations with unknown or varied disease stage). In metastatic patients, however, more consistent findings supported an association between serum CRP and prognosis (hazard ratio for overall survival: 1.87 (95% CI 1.31-2.67). Only five studies examined a role in prediction or monitoring of therapeutic response. One study reported a significant association between serum CRP levels and response to chemotherapy. Findings regarding serum CRP as a biomarker in breast cancer appear inconsistent, particularly in non-metastatic and general breast cancer, where the prognostic value could not be confirmed. In patients with metastatic breast cancer we suggest that high serum CRP is an indicator of poor prognosis. Too few studies assessed the role of serum CRP in prediction or monitoring of treatment response to allow conclusions.
炎症是癌症标志性特征的一个促成因素。因此，循环炎症生物标志物在癌症中的临床价值引起了越来越多的关注。在这篇综述中，我们总结了单独使用 C 反应蛋白（CRP）或作为格拉斯哥预后评分（GPS，由 CRP 和血清白蛋白组成）一部分的结果，作为预测乳腺癌患者预后或预测和监测治疗反应的生物标志物。在 Medline 和 Embase 中进行了系统的文献检索，检索时间从 1990 年到 2021 年 8 月。使用随机效应模型对血清 CRP 与总生存率和疾病/无进展生存率的相关性进行了荟萃分析。总共纳入了 35 项研究（20936 名患者）的结果，根据三种确定的患者情况（转移性、非转移性和一般情况）进行了划分。大多数研究都检查了预后的实用性。一些较大的研究观察到高血清 CRP 与不良生存率之间存在关联，但荟萃分析表明，在非转移性和一般乳腺癌患者中（疾病阶段未知或不同的患者），其价值有限。然而，在转移性患者中，更多的一致性发现支持血清 CRP 与预后之间的关联（总生存率的危险比：1.87（95%CI 1.31-2.67））。只有五项研究探讨了在预测或监测治疗反应方面的作用。一项研究报告了血清 CRP 水平与化疗反应之间存在显著相关性。关于血清 CRP 作为乳腺癌生物标志物的研究结果不一致，尤其是在非转移性和一般乳腺癌中，无法确认其预后价值。在转移性乳腺癌患者中，我们认为高血清 CRP 是预后不良的标志。评估血清 CRP 在预测或监测治疗反应中的作用的研究太少，无法得出结论。
