Koji Amano1, Isseki Maeda2, Tatsuya Morita3, Tomofumi Miura4, Satoshi Inoue5, Masayuki Ikenaga6, Yoshihisa Matsumoto4, Mika Baba7, Ryuichi Sekine8, Takashi Yamaguchi9, Takeshi Hirohashi10, Tsukasa Tajima11, Ryohei Tatara12, Hiroaki Watanabe13, Hiroyuki Otani14, Chizuko Takigawa15, Yoshinobu Matsuda16, Hiroka Nagaoka17, Masanori Mori18, Hiroya Kinoshita4. 1. Department of Palliative Medicine, Osaka City General Hospital, Osaka City, Osaka, Japan. Electronic address: kojiamano4813@gmail.com. 2. Department of Palliative Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan. 3. Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan. 4. Department of Palliative Medicine, National Cancer Hospital East, Kashiwa, Chiba, Japan. 5. Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan. 6. Children's Hospice Hospital, Yodogawa Christian Hospital, Osaka City, Osaka, Japan. 7. Department of Palliative Care, Saito Yukoukai Hospital, Ibaragi, Osaka, Japan. 8. Department of Pain and Palliative Care, Kameda Medical Center, Kamogawa, Chiba, Japan. 9. Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan. 10. Department of Palliative Care, Mitui Memorial Hospital, Tokyo, Japan. 11. Department of Palliative Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan. 12. Department of Palliative Medicine, Osaka City General Hospital, Osaka City, Osaka, Japan. 13. Department of Palliative Medicine, Komaki City Hospital, Komaki, Aichi, Japan. 14. Department of Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center, Fukuoka City, Fukuoka, Japan. 15. Department of Palliative Care, KKR Sapporo Medical Center, Sapporo, Hokkaido, Japan. 16. Department of Psychosomatic Medicine, National Hospital, Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan. 17. Department of Medical Social Service Center for Palliative and Supportive Care, University of Tsukuba, Tsukuba, Ibaraki, Japan. 18. Department of Palliative Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan.
Abstract
CONTEXT: Plasma C-reactive protein (CRP) levels are elevated in patients with advanced cancer. OBJECTIVES: To investigate CRP as a prognostic marker in palliative settings. METHODS: This multicenter prospective cohort study comprised 2426 patients. Laboratory data were obtained at baseline, and all patients were followed until death or six months after their enrollment. A total of 1511 patients were eligible for the analyses. They were divided into four groups: low-CRP (CRP < 1 mg/dL), moderate-CRP (1 ≤ CRP <5 mg/dL), high-CRP (5 ≤ CRP <10 mg/dL), and very high-CRP (10 mg/dL ≤ CRP) groups. Survival was investigated by the Kaplan-Meier method with the log-rank test. The 30-, 60-, and 90-day mortality rates were tested by Chi-squared tests. Univariate- and multivariate-adjusted hazard ratios (HRs) and 95% CIs in each group were calculated using Cox proportional hazard models. RESULTS: Survival rate decreased and mortality rate increased with increasing CRP level. The differences in survival and 30-, 60-, and 90-day mortality rates among the groups were statistically significant (P < 0.001). Baseline CRP level was significantly associated with a higher risk of mortality after adjustment for age, gender, primary tumor site, metastasis, chemotherapy, Eastern Cooperative Oncology Group Performance Status, and setting of care (moderate-CRP: HR 1.47 [95% CI 1.24-1.73], high-CRP: HR 2.09 [95% CI 1.74-2.50], and very high-CRP: HR 2.55 [95% CI 2.13-3.05] vs. low-CRP). CONCLUSION: Clear dose-effect relationships between elevated CRP levels and prognoses indicate that CRP could be useful in predicting prognoses in patients with advanced cancer.
CONTEXT: Plasma C-reactive protein (CRP) levels are elevated in patients with advanced cancer. OBJECTIVES: To investigate CRP as a prognostic marker in palliative settings. METHODS: This multicenter prospective cohort study comprised 2426 patients. Laboratory data were obtained at baseline, and all patients were followed until death or six months after their enrollment. A total of 1511 patients were eligible for the analyses. They were divided into four groups: low-CRP (CRP < 1 mg/dL), moderate-CRP (1 ≤ CRP <5 mg/dL), high-CRP (5 ≤ CRP <10 mg/dL), and very high-CRP (10 mg/dL ≤ CRP) groups. Survival was investigated by the Kaplan-Meier method with the log-rank test. The 30-, 60-, and 90-day mortality rates were tested by Chi-squared tests. Univariate- and multivariate-adjusted hazard ratios (HRs) and 95% CIs in each group were calculated using Cox proportional hazard models. RESULTS: Survival rate decreased and mortality rate increased with increasing CRP level. The differences in survival and 30-, 60-, and 90-day mortality rates among the groups were statistically significant (P < 0.001). Baseline CRP level was significantly associated with a higher risk of mortality after adjustment for age, gender, primary tumor site, metastasis, chemotherapy, Eastern Cooperative Oncology Group Performance Status, and setting of care (moderate-CRP: HR 1.47 [95% CI 1.24-1.73], high-CRP: HR 2.09 [95% CI 1.74-2.50], and very high-CRP: HR 2.55 [95% CI 2.13-3.05] vs. low-CRP). CONCLUSION: Clear dose-effect relationships between elevated CRP levels and prognoses indicate that CRP could be useful in predicting prognoses in patients with advanced cancer.
Authors: Jason W Boland; Victoria Allgar; Elaine G Boland; Mike I Bennett; Stein Kaasa; Marianne Jensen Hjermstad; Miriam Johnson Journal: Eur J Clin Pharmacol Date: 2019-12-21 Impact factor: 2.953
Authors: Victoria Louise Reid; Rachael McDonald; Amara Callistus Nwosu; Stephen R Mason; Chris Probert; John E Ellershaw; Séamus Coyle Journal: PLoS One Date: 2017-04-06 Impact factor: 3.240