Evaluation of preoperative C-reactive protein aids in predicting poor survival in patients with curative colorectal cancer with poor lymph node assessment

Toiyama,Yuji; Fujikawa,Hiroyuki; Koike,Yuki; Saigusa,Susumu; Inoue,Yasuhiro; Tanaka,Koji; Mohri,Yasuhiko; Miki,Chikao; Kusunoki,Masato

doi:10.3892/ol.2013.1308

Evaluation of preoperative C-reactive protein aids in predicting poor survival in patients with curative colorectal cancer with poor lymph node assessment

Authors:
- Yuji Toiyama
- Hiroyuki Fujikawa
- Yuki Koike
- Susumu Saigusa
- Yasuhiro Inoue
- Koji Tanaka
- Yasuhiko Mohri
- Chikao Miki
- Masato Kusunoki
View Affiliations

Affiliations: Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
Published online on: April 16, 2013 https://doi.org/10.3892/ol.2013.1308
Pages: 1881-1888

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

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.

View Figures

View References

1	Moertel CG: Chemotherapy for colorectal cancer. N Engl J Med. 330:1136–1142. 1994. View Article : Google Scholar : PubMed/NCBI
2	Joseph NE, Sigurdson ER, Hanlon AL, et al: Accuracy of determining nodal negativity in colorectal cancer on the basis of the number of nodes retrieved on resection. Ann Surg Oncol. 10:213–218. 2003. View Article : Google Scholar : PubMed/NCBI
3	Baxter NN, Virnig DJ, Rothenberger DA, Morris AM, Jessurun J and Virnig BA: Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst. 97:219–225. 2005. View Article : Google Scholar : PubMed/NCBI
4	Chang GJ, Rodriguez-Bigas MA, Skibber JM and Moyer VA: Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst. 99:433–441. 2007. View Article : Google Scholar : PubMed/NCBI
5	Mamounas E, Wieand S, Wolmark N, et al: Comparative efficacy of adjuvant chemotherapy in patients with Dukes’ B versus Dukes’ C colon cancer: results from four National Surgical Adjuvant Breast and Bowel Project adjuvant studies (C-01, C-02, C-03, and C-04). J Clin Oncol. 17:1349–1355. 1999.
6	Ratto C, Sofo L, Ippoliti M, et al: Accurate lymph-node detection in colorectal specimens resected for cancer is of prognostic significance. Dis Colon Rectum. 42:143–158. 1999. View Article : Google Scholar : PubMed/NCBI
7	Caplin S, Cerottini JP, Bosman FT, Constanda MT and Givel JC: For patients with Dukes’ B (TNM stage II) colorectal carcinoma, examination of six or fewer lymph nodes is related to poor prognosis. Cancer. 83:666–672. 1998.
8	Nelson H, Petrelli N, Carlin A, et al: Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 93:583–596. 2001. View Article : Google Scholar : PubMed/NCBI
9	Prandi M, Lionetto R, Bini A, et al: Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of a secondary analysis of a large scale adjuvant trial. Ann Surg. 235:458–463. 2002. View Article : Google Scholar
10	Wong SL, Ji H, Hollenbeck BK, Morris AM, Baser O and Birkmeyer JD: Hospital lymph node examination rates and survival after resection for colon cancer. JAMA. 298:2149–2154. 2007. View Article : Google Scholar : PubMed/NCBI
11	Noura S, Ohue M, Kano S, et al: Impact of metastatic lymph node ratio in node-positive colorectal cancer. World J Gastrointest Surg. 2:70–77. 2010. View Article : Google Scholar : PubMed/NCBI
12	Nakazaki H: Preoperative and postoperative cytokines in patients with cancer. Cancer. 70:709–713. 1992. View Article : Google Scholar : PubMed/NCBI
13	Nozoe T, Matsumata T, Kitamura M and Sugimachi K: Significance of preoperative elevation in serum C-reactive protein as an indicator for prognosis in colorectal cancer. Am J Surg. 176:335–338. 1998. View Article : Google Scholar : PubMed/NCBI
14	Nozoe T, Matsumata T and Sugimachi K: Preoperative elevation of serum C-reactive protein is related to impaired immunity in patients with colorectal cancer. Am J Clin Oncol. 23:263–266. 2000. View Article : Google Scholar : PubMed/NCBI
15	Gunter MJ, Stolzenberg-Solomon R, Cross AJ, et al: A prospective study of serum C-reactive protein and colorectal cancer risk in men. Cancer Res. 66:2483–2487. 2006. View Article : Google Scholar : PubMed/NCBI
16	Miki C, Konishi N, Ojima E, Hatada T, Inoue Y and Kusunoki M: C-reactive protein as a prognostic variable that reflects uncontrolled up-regulation of the IL-1-IL-6 network system in colorectal carcinoma. Dig Dis Sci. 49:970–976. 2004. View Article : Google Scholar : PubMed/NCBI
17	Koike Y, Miki C, Okugawa Y, et al: Preoperative C-reactive protein as a prognostic and therapeutic marker for colorectal cancer. J Surg Oncol. 98:540–544. 2008. View Article : Google Scholar : PubMed/NCBI
18	Wiggers T, Arends JW, Schutte B, Volovics L and Bosman FT: A multivariate analysis of pathologic prognostic indicators in large bowel cancer. Cancer. 61:386–395. 1988. View Article : Google Scholar : PubMed/NCBI
19	Fletcher RH: Carcinoembryonic antigen. Ann Int Med. 104:66–73. 1986. View Article : Google Scholar
20	Moertel CG, Fleming TR, Macdonald JS, Haller DG, Laurie JA and Tangen C: An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer. JAMA. 270:943–947. 1993. View Article : Google Scholar : PubMed/NCBI
21	Tepper JE, O’Connell MJ, Niedzwiecki D, et al: Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol. 19:157–163. 2001.PubMed/NCBI
22	Joseph NE, Sigurdson ER, Hanlon AL, et al: Colon cancer survival is associated with increasing number of lymph nodes analyzed: A secondary survey of intergroup trial INT-0089. J Clin Oncol. 21:2912–2919. 2003. View Article : Google Scholar : PubMed/NCBI
23	Swanson RS, Compton CC, Stewart AK and Bland KI: The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol. 10:65–71. 2003. View Article : Google Scholar : PubMed/NCBI
24	Bilimoria KY, Palis B, Stewart AK, et al: Impact of tumor location on nodal evaluation for colon cancer. Dis Colon Rectum. 51:154–161. 2008. View Article : Google Scholar : PubMed/NCBI
25	Leibl S, Tsybrovskyy O and Denk H: How many lymph nodes are necessary to stage early and advanced adenocarcinoma of the sigmoid colon and upper rectum? Virchows Arch. 443:133–138. 2003. View Article : Google Scholar : PubMed/NCBI
26	Horzic M and Kopljar M: Minimal number of lymph nodes that need to be examined for adequate staging of colorectal cancer – factors influencing lymph node harvest. Hepatogastroenterology. 52:86–89. 2005.PubMed/NCBI
27	AJCC Cancer Staging Manual. 6th edition. Springer; New York: 2002
28	Le Voyer TE, Sigurdson ER, Hanlon AL, et al: Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol. 21:2912–2919. 2003.PubMed/NCBI
29	Nitti D, Marchet A, Olivieri M, et al: Ratio between metastatic and examined lymph nodes is an independent prognostic factor after D2 resection for gastric cancer: analysis of a large European monoinstitutional experience. Ann Surg Oncol. 10:1077–1085. 2003. View Article : Google Scholar
30	Voordeckers M, Vinh-Hung V, Van de Steene J, Lamote J and Storme G: The lymph node ratio as prognostic factor in node-positive breast cancer. Radiother Oncol. 70:225–230. 2004. View Article : Google Scholar : PubMed/NCBI
31	Berger AC, Watson JC, Ross EA and Hoffman JP: The metastatic/examined lymph node ratio is an important prognostic factor after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am Surg. 70:235–240. 2004.
32	Inoue K, Nakane Y, Iiyama H, et al: The superiority of ratio-based lymph node staging in gastric carcinoma. Ann Surg Oncol. 9:27–34. 2002. View Article : Google Scholar : PubMed/NCBI
33	Berger AC, Sigurdson ER, LeVoyer T, et al: Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol. 23:8706–8712. 2005. View Article : Google Scholar : PubMed/NCBI
34	Lee HY, Choi HJ, Park KJ, et al: Prognostic significance of metastatic lymph node ratio in node-positive colon carcinoma. Ann Surg Oncol. 14:1712–1717. 2007. View Article : Google Scholar : PubMed/NCBI
35	Wang J, Hassett JM, Dayton MT and Kulaylat MN: Lymph node ratio: role in the staging of node-positive colon cancer. Ann Surg Oncol. 15:1600–1608. 2008. View Article : Google Scholar : PubMed/NCBI
36	Rosenberg R, Friederichs J, Schuster T, et al: Prognosis of patients with colorectal cancer is associated with lymph node ratio: a single-center analysis of 3,026 patients over a 25-year time period. Ann Surg. 248:968–978. 2008.PubMed/NCBI
37	Peng J, Xu Y, Guan Z, et al: Prognostic significance of the metastatic lymph node ratio in node-positive rectal cancer. Ann Surg Oncol. 15:3118–3123. 2008. View Article : Google Scholar : PubMed/NCBI