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

Yukinori Kurokawa1, Kotaro Yamashita2, Ryohei Kawabata3

  • 1Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan. ykurokawa@gesurg.med.osaka-u.ac.jp.

Gastric Cancer : Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association
|April 22, 2020
PubMed
Summary

Postoperative C-reactive protein (CRP) elevation is a more reliable prognostic indicator than complications in gastric cancer patients. Elevated CRP levels (≥12 mg/dL) predict worse recurrence-free survival, independent of complications.

Keywords:
C-reactive proteinGastrectomyGastric cancerPostoperative complication

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Biomarkers

Background:

  • Postoperative complications negatively impact patient prognosis in malignancies.
  • Previous research indicated C-reactive protein (CRP) elevation as a superior prognostic indicator over complications.
  • This study validates the prognostic value of postoperative CRP in resectable gastric cancer.

Purpose of the Study:

  • To confirm the prognostic significance of postoperative C-reactive protein (CRP) elevation.
  • To compare the predictive value of CRPmax versus intra-abdominal infectious complications for recurrence-free survival (RFS) in gastric cancer.

Main Methods:

  • Large-scale, multicenter study involving 1456 patients with pT2-T4 gastric cancer undergoing R0 resection.
  • Evaluation of the highest postoperative serum CRP level (CRPmax) using Kaplan-Meier analysis.
  • Assessment of CRPmax prognostic independence using Cox multivariate analysis for recurrence-free survival (RFS).

Main Results:

  • Higher CRPmax (≥12 mg/dL) was significantly associated with worse RFS (P=.002).
  • Liver metastasis was more frequent in the high CRPmax group (9.2% vs. 4.7%, P=.001).
  • CRPmax was an independent prognostic factor (P=.043), while postoperative complications were not (P=.387).

Conclusions:

  • Postoperative C-reactive protein (CRP) elevation is a more effective predictor of prognosis in gastric cancer patients than intra-abdominal infectious complications.
  • Elevated CRPmax is a significant independent prognostic factor for recurrence-free survival in resectable gastric cancer.