Ugo Pastorino1, Daniele Morelli2, Giovanni Leuzzi3, Luigi Rolli3, Paola Suatoni3, Francesca Taverna4, Elena Bertocchi3, Mattia Boeri5, Gabriella Sozzi5, Anna Cantarutti6, Giovanni Corrao6, Alessandro Gronchi7. 1. Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. ugo.pastorino@istitutotumori.mi.it. 2. Biochemical Laboratory, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 3. Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 4. Immuno-Haematology and Transfusion Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 5. Tumour Genomics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 6. Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy. 7. Sarcoma Service - Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. alessandro.gronchi@istitutotumori.mi.it.
Abstract
BACKGROUND: Blood level of C-reactive protein (CRP) at diagnosis is a well-know prognostic bio-marker in different primary tumors, but its role has not been investigated in resectable lung metastases. The aim of our study is to assess the predictive value of baseline (CRP0) and 3rd postoperative day (CRP3) levels on long-term survival of patients undergoing lung metastasectomy. METHODS: A total of 846 consecutive patients underwent the first pulmonary resection for lung metastases between January 2003 and December 2015, including 611 (72%) single surgical procedures, 235 (28%) multiple metastasectomies, 501 (59%) epithelial primary tumors, 276 (33%) sarcomas, 66 (8%) melanomas, 286 (33.8%) with 0 risk factors (CRP0 ≤ 2 and CRP3 ≤ 84 mg/L) and 560 (66.2%) with ≥ 1 risk factor (CRP0 > 2 and/or CRP3 > 84 mg/L). RESULTS: Cumulative 5-year survival was 57% in patients with low CRP (0 risk factors) versus 43% in high CRP (≥ 1 risk factor, p < 0.0002), 62% versus 50% respectively for epithelial tumors (p < 0.0140), and 51% versus 34% for sarcomas (p < 0.0111). Multivariable Cox analysis confirmed a mortality hazard ratio of 2.5 at 1-year and 1.5 at 5-years in patients with high CRP. CONCLUSIONS: Baseline and postoperative CRP levels predict survival of patients with resectable lung metastases. These data provide a rationale for prospective clinical trials testing the efficacy of anti-inflammatory or immune-modulating agents as "adjuvant" therapy after lung metastasectomy, in patients with elevated pre- and/or postoperative CRP levels.
BACKGROUND: Blood level of C-reactive protein (CRP) at diagnosis is a well-know prognostic bio-marker in different primary tumors, but its role has not been investigated in resectable lung metastases. The aim of our study is to assess the predictive value of baseline (CRP0) and 3rd postoperative day (CRP3) levels on long-term survival of patients undergoing lung metastasectomy. METHODS: A total of 846 consecutive patients underwent the first pulmonary resection for lung metastases between January 2003 and December 2015, including 611 (72%) single surgical procedures, 235 (28%) multiple metastasectomies, 501 (59%) epithelial primary tumors, 276 (33%) sarcomas, 66 (8%) melanomas, 286 (33.8%) with 0 risk factors (CRP0 ≤ 2 and CRP3 ≤ 84 mg/L) and 560 (66.2%) with ≥ 1 risk factor (CRP0 > 2 and/or CRP3 > 84 mg/L). RESULTS: Cumulative 5-year survival was 57% in patients with low CRP (0 risk factors) versus 43% in high CRP (≥ 1 risk factor, p < 0.0002), 62% versus 50% respectively for epithelial tumors (p < 0.0140), and 51% versus 34% for sarcomas (p < 0.0111). Multivariable Cox analysis confirmed a mortality hazard ratio of 2.5 at 1-year and 1.5 at 5-years in patients with high CRP. CONCLUSIONS: Baseline and postoperative CRP levels predict survival of patients with resectable lung metastases. These data provide a rationale for prospective clinical trials testing the efficacy of anti-inflammatory or immune-modulating agents as "adjuvant" therapy after lung metastasectomy, in patients with elevated pre- and/or postoperative CRP levels.
Authors: Florian Primavesi; Valentina Andreasi; Frederik J H Hoogwater; Stefano Partelli; Dominik Wiese; Charlotte Heidsma; Benno Cardini; Eckhard Klieser; Katharina Marsoner; Uwe Fröschl; Sabine Thalhammer; Ines Fischer; Georg Göbel; Andreas Hauer; Tobias Kiesslich; Philipp Ellmerer; Reinhold Klug; Daniel Neureiter; Helwig Wundsam; Franz Sellner; Peter Kornprat; Reinhold Függer; Dietmar Öfner; Elisabeth J M Nieveen van Dijkum; Detlef K Bartsch; Ruben H J de Kleine; Massimo Falconi; Stefan Stättner Journal: Cancers (Basel) Date: 2020-05-14 Impact factor: 6.639