Correlation of C-Reactive Protein with Survival and Radiographic Response to First-Line Platinum-Based Chemotherapy in Advanced Non-Small Cell Lung Cancer
Medizinische Klinik IV, Universitatsklinikum Aachen, RWTH Aachen, Germany. Onkologie
(Impact Factor: 0.86).
02/2008; 31(12):665-70. DOI: 10.1159/000165054
This study was conducted to assess the prognostic role of regular measurements of C-reactive protein (CRP) in patients with advanced-stage non-small cell lung cancer (NSCLC) during platinum-based first-line therapy.
A total of 210 patients were retrospectively analyzed regarding CRP values, infections, histological type, stage, performance status, gender, age, body mass index and survival. Additionally, in 88 of these patients, changes of CRP values were correlated with response to chemotherapy by radiographic imaging.
Elevation of CRP prior to the first cycle was an adverse prognostic factor for overall survival. Comparing CRP values before and after 2 cycles correlated with response and identified patient groups with a remarkable difference of overall survival (18.8 vs. 7.5 months). Normalization of CRP was associated with a low risk for progression, whereas patients with an increase of CRP values of more than 25% showed a progressive disease in most cases. Besides performance status, no correlation of CRP with other clinical data was found.
Measurement of CRP before initiation and during a platinum-based chemotherapy can provide prognostic information for the individual patient with advanced NSCLC and is able to support or even replace assessment of response by radiographic imaging in defined situations.
Available from: Florian Kocher
- "There are constantly updated guidelines providing evidencebased advices on treatment of NSCLC (non-small cell lung cancer) (e.g. the ESMO guidelines) . However literature offering a global view on the disease is sparse since most studies only focus on distinct aspects of the disease like: presenting symptoms , comorbidities , laboratory features  , different treatment approaches  or temporal trends . In contrast the TYROL (Twenty-Year Retrospective of Lung Cancer) registry was started more than a decade ago in order to get a comprehensive and unbiased view on lung cancer and its treatment in a representative Western society in daily routine. "
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The aim of this study was to describe a large consecutive cohort of non-small cell lung cancer (NSCLC) patients treated in daily routine within the last 25 years. An extensive list of general baseline characteristics (comorbidities, laboratory values, symptoms, performance state), NSCLC related factors (stage, histology), treatment related parameters (approach, applied therapies) and outcome (PFS, RFS, OS, perspective of decades) were analyzed in detail.
Patients and methods:
Medical files of 2293 consecutive NSCLC patients diagnosed between 1989 and 2009 at the Medical University of Innsbruck and affiliated hospitals were retrospectively analyzed. Patients were documented within our institution's comprehensive lung cancer project "Twenty-Year Retrospective of Lung Cancer (TYROL study)".
Mean age at diagnosis was 64.1 years and 1611 patients (70.3%) were male. Most patients were diagnosed in stage IV (37.9%). The most frequent comorbidities present at diagnosis were cardiovascular disease (62.1%) and COPD (62.0%). The most common symptoms at diagnosis were coughing (54.7%) and dyspnea (45.3%). Of all 2293 patients 1981 (86.4%) received adequate antineoplastic treatment. In total 874 patients were radically operated, 119 received radiotherapy/radio-chemotherapy and the majority of patients (n=1278) were treated in palliative intent. A 2nd, 3rd, 4th and 5th-line palliative therapy was administered to 612, 278, 102, and 36 patients. Median OS, RFS and PFS were 16.4 months, 86.4 months and 5.1 months, respectively. A multitude of factors was associated with all three outcome variables. Of note, outcome has improved stepwise in the recent decade based on increased response rates leading to prolonged OS.
This work incorporates most clinical aspects relevant in the treatment of NSCLC and beyond. Therefore, this comprehensive analysis provides a definite benchmark for prognostication and epidemiology of NSCLC in a Western European society.
Available from: PubMed Central
- "Moreover, we found that pretherapeutic C-reactive protein level below 7 mg/L was strongly correlated with survival in multivariate analysis. In a study conducted by Wilop on 210 patients with NSCLC stage IV, evolution of CRP allowed to identify two subgroups of patients with significant differences in survival (18,8 vs 7,5 months)
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In non-small cell lung cancer patients (NSCLC), median survival from the time patients develop bone metastasis is classically described being inferior to 6 months. We investigated the subcategory of patients having an inaugural skeletal-related-event revealing NSCLC. The purpose of this study was to assess the impact of bone involvement on overall survival and to determine biological and tumoral prognosis factors on OS and PFS. An analysis of the subgroup of solitary bone metastasis patients was also performed.
In a population of 1208 lung cancer patients, 55 consecutive NSCLC patients revealed by inaugural bone metastasis and treated between 2003 and 2010, were retrospectively analysed. Survival was measured with a Kaplan-Meyer curve. Univariate and multivariate analysis were performed using the Stepwise Cox proportional hazard regression model. A p value of less than 0,05 was considered statistically significant.
Estimated incidence of revealing bone metastasis is 4,5% among newly diagnosed lung cancer patients. Median duration of skeletal symptoms before diagnosis was 3 months and revealing bone site was located on axial skeleton in 70% of the cases. Histology was adenocarcinoma (78%), with small primary tumors Tx-T1-2 accounting for 71% of patients. Rate of second SRE is 37%.Median overall survival was 8.15 months, IQR [5-16 months], mean survival 13.4 months, and PFS was 3.5 months. In multivariate analysis, variables significantly associated with shortened survival were advanced T stage (HR=2.8; p=0.004), weight loss>10% (HR=3.1; p=0.02), inaugural spinal epidural metastasis (HR 2.5; p=0.0036), elevated C-reactive protein (HR=4.3; p=0.002) and TTF-1 status (HR=2.42; p=0.004). Inaugural spinal epidural metastasis is a very strong adverse pronostic factor in these cases, with a 3 months median survival. Single bone metastasis patients showed prolonged survival of 14.2 months versus 7.6 months, only in univariate analysis (HR=0.42; p=0.0059).
Prognosis of lung cancer patients with inaugural SRE remains pejorative. Accurately estimating the survival of this population is helpful for bone surgical decision-making at diagnosis. The trend for a higher proportion of adenocarcinoma in NSCLC patients should result with an increasing number of patients with inaugural SRE at diagnosis.
Available from: Donald C Mcmillan
- "Recent work shows that the effect of systemic inflammation is detrimental in terms of outcome in cancer in general   and in lung cancer specifically        . The combination "
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ABSTRACT: Background. Prediction of survival in patients diagnosed with lung cancer remains problematical. The aim of the present study was to examine the clinical utility of an established objective marker of the systemic inflammatory response, the Glasgow Prognostic Score, as the basis of risk stratification in patients with lung cancer. Methods. Between 2005 and 2008 all newly diagnosed lung cancer patients coming through the multidisciplinary meetings (MDTs) of four Scottish centres were included in the study. The details of 882 patients with a confirmed new diagnosis of any subtype or stage of lung cancer were collected prospectively. Results. The median survival was 5.6 months (IQR 4.8-6.5). Survival analysis was undertaken in three separate groups based on mGPS score. In the mGPS 0 group the most highly predictive factors were performance status, weight loss, stage of NSCLC, and palliative treatment offered. In the mGPS 1 group performance status, stage of NSCLC, and radical treatment offered were significant. In the mGPS 2 group only performance status and weight loss were statistically significant. Discussion. This present study confirms previous work supporting the use of mGPS in predicting cancer survival; however, it goes further by showing how it might be used to provide more objective risk stratification in patients diagnosed with lung cancer.
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