The value of C-reactive protein and comorbidity in predicting survival of patients with high grade soft tissue sarcoma

Background: The aim of this study was to determine whether C-reactive protein (CRP) levels or patient's comorbidity before treatment predicted the overall disease-specific survival and local tumour control in high grade soft tissue sarcoma patients.

Methods: A total of 332 primary adult soft tissue sarcoma patients were retrospectively reviewed. CRP levels were obtained prior to treatment for all patients. The Charlson comorbidity index (CCI) was used for evaluation as a measure of comorbidity. Patients that presented with metastases at diagnosis were excluded from this study.

Results: Elevated CRP levels were seen in 152 patients. CCI score varied from 0 to 4. Two-hundred and sixty-five patients had a score of 0 (no identified comorbidity), and 67 patients had a score of 1 or more. Patients with elevated CRP levels prior to initial treatment had a poorer disease-specific survival (42% at 5 years) than patients with normal CRP levels (82% at 5 years) (p<0.0001). Patients with elevated CRP levels had a poorer local recurrence-free rate after initial treatment (75% at 5 years) than patients with normal CRP levels (89% at 5 years) (p=0.0004). Multivariate analysis also showed the preoperative CRP level to be an independent predictor of survival and local control. Although age in patients with identified comorbidity was significantly higher than those in patients with no-identified comorbidity, CCI was not a predictive factor for either survival or local control.

Conclusion: Pretreatment elevated CRP levels were found to be a poor prognostic factor for disease-specific survival and local control for soft tissue sarcoma patients.