Jun Lu1,2,3, Bin-Bin Xu1,2,3, Zhen Xue1,2,3, Jian-Wei Xie1,2,3, Chao-Hui Zheng1,2,3, Chang-Ming Huang1,2,3, Ping Li1,2,3. 1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China. 2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. 3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.
Abstract
BACKGROUND: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). METHODS: 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-CRPmax ), was derived. Multivariate analysis was performed to further explore the independent variates for recurrence-free survival (RFS). RESULTS: 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-CRPmax 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-CRPmax 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-CRPmax ≥77.1 mg/L (high-post-CRPmax ) 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-CRPmax ≥77.1 mg/L but not post-CRPmax <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. CONCLUSIONS: Both high-pre-CRP and high-post-CRPmax 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-CRPmax ≥77.1 mg/L after radical gastrectomy. Further studies are needed to confirm these findings and explore the potential mechanism.
RCT Entities:
BACKGROUND: Perioperative C-reactive protein (CRP) levels have effects on the prognosis of cancerpatients. We intended to determine the prognostic value of combining the two for gastric cancer (GC). METHODS: 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-CRPmax ), was derived. Multivariate analysis was performed to further explore the independent variates for recurrence-free survival (RFS). RESULTS: 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-CRPmax 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-CRPmax 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-CRPmax ≥77.1 mg/L (high-post-CRPmax ) 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-CRPpatients, only patients with post-CRPmax ≥77.1 mg/L but not post-CRPmax <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. CONCLUSIONS: Both high-pre-CRP and high-post-CRPmax 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-CRPmax ≥77.1 mg/L after radical gastrectomy. Further studies are needed to confirm these findings and explore the potential mechanism.
Authors: Yoon Young Choi; Hyunki Kim; Su-Jin Shin; Ha Yan Kim; Jinae Lee; Han-Kwang Yang; Woo Ho Kim; Young-Woo Kim; Myeong-Cherl Kook; Young Kyu Park; Hyung-Ho Kim; Hye Seung Lee; Kyung Hee Lee; Mi Jin Gu; Seung Ho Choi; SoonWon Hong; Jong Won Kim; Woo Jin Hyung; Sung Hoon Noh; Jae-Ho Cheong Journal: Ann Surg Date: 2019-08 Impact factor: 12.969
Authors: Susan Tsai; Ben George; David Wittmann; Paul S Ritch; Ashley N Krepline; Mohammed Aldakkak; Chad A Barnes; Kathleen K Christians; Kulwinder Dua; Michael Griffin; Catherine Hagen; William A Hall; Beth A Erickson; Douglas B Evans Journal: Ann Surg Date: 2020-04 Impact factor: 12.969