Gunter MJ, Stolzenberg-Solomon R, Cross AJ, et al. A prospective study of serum C-reactive protein and colorectal cancer risk in men

Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Rockville, Maryland 20852, USA.
Cancer Research (Impact Factor: 9.33). 03/2006; 66(4):2483-7. DOI: 10.1158/0008-5472.CAN-05-3631
Source: PubMed


Chronic inflammation has been implicated in the etiology of colorectal cancer. C-reactive protein (CRP), a sensitive marker of inflammation, has been investigated with regard to colorectal cancer in only three previous studies, and the results from these investigations were inconsistent. We examined serum CRP levels in relation to colorectal cancer incidence in a nested case-control study within the Alpha Tocopherol, Beta-Carotene (ATBC) Cancer Prevention Study, a cohort of 29,133 Finnish males enrolled from 1985 to 1988 with follow-up through April 2002. Colorectal cancer cases were ascertained by the Finnish Cancer Registry; this analysis included 130 cases of colorectal cancer (with available blood), which occurred between 1990 and April 30, 2002, and 260 matched controls. Baseline median CRP levels were approximately 25% higher among colorectal cancer cases (3.4 mg/L) than controls (2.6 mg/L; P = 0.04). Relative to men in the lowest quartile of CRP concentration, men in the highest quartile had an odds ratio of 2.9 (95% confidence interval, 1.4-6.0) for developing colorectal cancer with a dose-response relationship supported (P(trend) = 0.006). The relation between CRP and incident colorectal cancer was modified by body mass index such that the association was stronger among lean individuals than in heavier individuals (P(interaction) = 0.018). These results support the notion that chronic low-grade inflammation is a marker for increased risk of colorectal cancer.

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Available from: Richard J Wood, Apr 23, 2014
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    • "Cyclooxygenase-2 inhibitors and nonsteroidal anti-inflammatory drugs (NSAIDs) were found to decrease the incidence of colorectal adenoma, and NSAIDs were also found to reduce the incidence of CRC [4]. Elevated C-reactive protein (CRP), which is a marker of systemic inflammation was reported as the risk factor for CRC [5]. "
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    ABSTRACT: Purpose This study was conducted to evaluate the systemic inflammatory response in colorectal cancer patients, and to estimate the usefulness of the Glasgow prognostic score (GPS) as a prognostic factor. Methods Patients with biopsy-proven colorectal adenocarcinoma who were operated between April 2005 and December 2008 were enrolled in this study. The GPS was estimated based on the measurement of CRP and serum albumin level. The GPS was compared with other clinicopathological factors. Univariate and multivariate analyses were performed to evaluate the factors affecting cancer-specific survival. Results GPS was significantly higher in patients with anemia, thrombocytosis, a high neutrophil to lymphocyte ratio, tumor of the colon, and large tumor. Patient age, gender, serum CEA level, tumor gross appearance, TNM stage, and tumor differentiation were not related with the GPS. In univariate analysis, hemoglobin, CEA, gross appearance of tumor, TNM stage, tumor differentiation, and GPS were associated with cancer-specific survival. In multivariate analysis, TNM stage (III or IV : I or II; hazard ratio [HR], 12.322; P = 0.015), tumor differentiation (poorly differentiated : well or moderately differentiated; HR, 3.112; P = 0.021), and GPS (GPS 2 : GPS 0 or 1; HR, 5.168; P = 0.003) were identified as independent prognostic factors in colorectal cancer. Conclusion Our study showed that the GPS was an independent variable from tumor stage and a good and convenient prognostic factor in colorectal cancer patients.
    Annals of Surgical Treatment and Research 06/2014; 86(6):309-13. DOI:10.4174/astr.2014.86.6.309
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    • "These results suggest the predictable potency of CRP in the mortality of CRC patients. Therefore, the results of the present study to a certain extent confirmed the conclusions of a number of previous studies which considered the positive pathological role of CRP in CRC (32–34,43). Possible reasons for the difference between the previous studies which indicated a negative association between CRP levels and clinical and pathological features in CRC patients, and other previous positive studies including the present one are probably partly attributable to the variable potential biological features, different stages, distribution of the patient population and the disparate territory. "
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    ABSTRACT: Elevated levels of C-reactive protein (CRP) have been described as a prognostic factor in various types of human malignancy. In the present study, the prognostic potency of CRP was validated for patients with colorectal cancer (CRC) in order to guide patient management and define high-risk populations for follow-up or for therapeutic purposes. The association between the high sensitivity-CRP (hs-CRP) levels of a total of 123 patients with CRC and their clinicopathological characteristics was explored. Subsequently, univariate and multivariate analyses were performed to investigate the survival impact of pre-treatment hs-CRP levels in this cohort study. Statistically significant correlations between the serum levels of hs-CRP and lymph node and distant metastasis (P<0.001 and P=0.012, respectively), vascular and perineural invasion (P<0.001 and P<0.001), grades (P=0.022) and clinical stages (P=0.001), but not age and gender (P=0.616 and 0.676, respectively), were found. The five-year survival rate of patients with elevated (>5.0 mg/l) hs-CRP levels was demonstrated to be significantly less than that of those in the normal group (≥5.0 mg/l) by applying the Kaplan-Meier method (13.3 versus 57.0%, log-rank test P<0.001). Furthermore, following identification as a prognostic factor through using univariate analysis, high levels of hs-CRP (P<0.001) were validated as an independent prognosticator in CRC in the present study through using multivariate analysis. Pre-treatment serum CRP levels were associated with advanced and progressed CRC patients, therefore these levels may serve as a potential prognostic marker for CRC patients.
    Experimental and therapeutic medicine 12/2013; 6(6):1369-1374. DOI:10.3892/etm.2013.1350 · 1.27 Impact Factor
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    • "It is synthesized in hepatocytes and is upregulated by cytokines such as interleukin (IL)-6 and tumor necrosis factor-α (12). Several studies have demonstrated that elevated CRP levels are associated with an increased risk of early recurrence and poor outcome following colorectal cancer resection (13–15). Previously, we also reported that CRP levels reflect IL-6 production in colorectal cancer tissues and predict poor prognosis in colorectal cancer patients, particularly in stage I or II patients who are not usually candidates for postoperative adjuvant chemotherapy (16,17). "
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    ABSTRACT: Lymph node status is the most significant prognostic factor of colorectal cancer. However, there is a risk of disease understaging if the extent of lymph node assessment is sub-optimal. Preoperative C-reactive protein (CRP) is known to be a useful tool in predicting postoperative outcomes in patients with colorectal cancer. We retrospectively evaluated whether CRP adds to prognosis information in stage I-III colorectal cancer patients with poor lymph node assessment. In stages I-III, multivariate analysis revealed that CRP-positive status and advanced T-stage were factors that independently affected survival. In stage III, univariate analysis revealed that lymph node number retrieval and lymph node ratio were factors that affected survival. However, CRP positivity was the only independent factor for survival. CRP positivity did not predict poor prognosis in stage II or III patients with adequate lymph node retrieval. By contrast, the prognosis of CRP-positive patients was poorer than that of CRP-negative patients in stage II and III, with inadequate lymph node retrieval. CRP is an independent prognostic marker in patients with stage I-III, II or III colorectal cancer. The evaluation of CRP may provide useful information on prognosis in curative patients with an inadequate examination of lymph nodes.
    Oncology letters 06/2013; 5(6):1881-1888. DOI:10.3892/ol.2013.1308 · 1.55 Impact Factor
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