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World J Gastroenterol. Jun 21, 2006; 12(23): 3746-3750
Published online Jun 21, 2006. doi: 10.3748/wjg.v12.i23.3746
Significance of preoperative C-reactive protein as a parameter of the perioperative course and long-term prognosis in squamous cell carcinoma and adenocarcinoma of the oesophagus
Ines Gockel, Kathrin Dirksen, Claudia M Messow, Theodor Junginger
Ines Gockel, Kathrin Dirksen, Theodor Junginger, Department of General and Abdominal Surgery, Johannes Gutenberg-University, Mainz, Germany
Claudia M Messow, Institute of Biostatistics and Documentation, Johannes Gutenberg-University, Mainz, Germany
Correspondence to: Ines Gockel, MD, Department of General and Abdominal Surgery, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, D-55101 Mainz,Germany. gockel@ach.klinik.uni-mainz.de
Telephone: +49-61-31177291 Fax: +49-61-31176630
Received: September 23, 2005
Revised: September 28, 2005
Accepted: November 18, 2005
Published online: June 21, 2006
Abstract

AIM: C-reactive protein (CRP) is an acute-phase reactant and a known indicator of the malignant potential of the tumour. The aim of this study was to investigate the significance of preoperative CRP as a parameter of the perioperative course and long-term prognosis in patients with squamous cell carcinoma and adenocarcinoma of the oesophagus.

METHODS: Serum CRP was determined preoperatively in 291 of 371 patients undergoing oesophagectomy for cancer from December 1989 to March 2004. Median patient age was 59 (28-79) year, 82.5% of patients were males. Squamous cell carcinoma was diagnosed in 151 (51.9%) and adenocarcinoma in 122 patients. Transhiatal oesophagectomy was done in 151 (51.9%) patients and 134 (46.0%) patients underwent the abdominothoracic procedure.

RESULTS: In 127 (43.6%) patients the preoperative serum CRP concentration was within the normal range (< 5 mg/dL), elevated CRP levels were measured in 164 (56.4%) patients. Tumour extension (P < 0.0005) and the number of lymph nodes affected by metastatic spread (P = 0.015) were significantly increased in the group with elevated CRP levels. Among the perioperative parameters both the number of blood transfusions (P = 0.006) and the general complication rate (P = 0.002) were higher in patients with elevated preoperative CRP levels. The long-term survival rate of 13.6 (0-109.8) mo was poorer in the group with elevated CRP levels compared to 18.9 (0-155.4) mo in the group with normal CRP levels (log-rank test: P = 0.107). Multivariate analysis with backward variables selection identified preoperative CRP as an independent prognostic factor of the long-term prognosis in patients with oesophageal carcinoma, with a hazard ratio of 1.182 (95% confidence interval: 1.030-1.356).

CONCLUSION: The preoperative serum CRP-level is an easily determined independent prognostic marker in patients with squamous cell carcinoma and adenocarcinoma of the oesophagus.

Keywords: Preoperative C-reactive protein; Perioperative course; Long-term prognosis; Squamous cell carcinoma; Adenocarcinoma; Oesophagus