Postoperative peak serum C-reactive protein predicts outcome of hepatic resection for hepatocellular carcinoma

In spite of improvements in surgical techniques, instruments, and perioperative management, hepatocellular carcinoma (HCC) recurs after hepatic resection in as many as 60-70% of patients. Therefore, it is important to predict tumor recurrence and prognosis in regard to decision making of additional adjuvant treatment after surgery. We investigated the relation between postoperative serum C-reactive protein (CRP) and tumor recurrence, as well as survival, in patients with HCC after elective hepatic resection.

The subjects of this study were 77 patients who underwent elective hepatic resection for HCC between January 2001 and December 2008. We retrospectively examined the relation between postoperative serum CRP, clinical variables, and recurrence of HCC, as well as overall survival.

For disease-free survival, preoperative ICGR15 (retention rate of indocyanine green at 15 min) of more than 15% (p=0.0039, p=0.0026), and advanced tumor stage (p=0.0380, p=0.0203) were significant and independent predictors of worse survival rate in univariate and multivariate analyses, respectively. For overall survival, female gender (p=0.0052, p=0.0021), preoperative ICGR15 of above 15% (p=0.0043, p=0.0153), advanced tumor stage (p=0.0063, p=0.0023), and postoperative peak serum CRP above 10 mg/dl (p=0.0309, p=0.0116) were significant and independent predictors of worse survival rate in univariate and multivariate analyses, respectively.

Postoperatively elevated serum CRP may be a prognostic indication after elective hepatic resection for patients with HCC.