Prognostic value of postoperative C-reactive protein elevation versus complication occurrence: a multicenter validation study.

Autor: Kurokawa Y; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan. ykurokawa@gesurg.med.osaka-u.ac.jp., Yamashita K; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan., Kawabata R; Department of Surgery, Osaka Rosai Hospital, Osaka, Japan., Fujita J; Department of Surgery, Sakai City Medical Center, Osaka, Japan., Imamura H; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan., Takeno A; Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan., Takahashi T; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan., Yamasaki M; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan., Eguchi H; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan., Doki Y; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
Jazyk: angličtina
Zdroj: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association [Gastric Cancer] 2020 Sep; Vol. 23 (5), pp. 937-943. Date of Electronic Publication: 2020 Apr 20.
DOI: 10.1007/s10120-020-01073-5
Abstrakt: Background: Several studies have shown that postoperative complications worsen the prognosis of patients with malignancies. However, our previous study showed that C-reactive protein (CRP) elevation over 12 mg/dL was a more reliable prognostic indicator than complication occurrence. This large-scale, multicenter validation study aimed to confirm the prognostic value of postoperative CRP elevation in resectable gastric cancer.
Methods: Data of 1456 patients with pT2-T4 gastric cancer who underwent R0 resection were collected from 21 institutions. The prognostic value of the highest postoperative serum level of CRP (CRP max ) during hospitalization was evaluated using the Kaplan-Meier method. The prognostic independence of CRP max with assessed with a Cox multivariate analysis of recurrence-free survival (RFS).
Results: RFS in the high CRP max (≥ 12 mg/dL) group was significantly worse than that in the low CRP max (< 12 mg/dL) group (log-rank P = 0.002). The recurrence pattern showed that liver metastasis occurred more frequently in the high CRP max group (9.2%) than in the low CRP max group (4.7%) (P = 0.001). In patients without intra-abdominal infectious complications, the high CRP max group showed significantly worse RFS than the low CRP max group (log-rank P = 0.026). In patients with intra-abdominal infectious complications, the high CRP max group had worse RFS than the low CRP max group, but this difference was not significant (log-rank P = 0.075). Cox multivariate analysis with 13 covariables showed that CRP max (P = 0.043) was an independent prognostic factor, but postoperative complications were not (P = 0.387).
Conclusion: Postoperative CRP elevation was a better predictor of prognosis in patients with gastric cancer than the occurrence of intra-abdominal infectious complications.
Databáze: MEDLINE
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