Elevated high-sensitivity C-reactive protein levels predict decreased survival for nasopharyngeal carcinoma patients in the intensity-modulated radiotherapy era

PLoS One. 2015 Apr 13;10(4):e0122965. doi: 10.1371/journal.pone.0122965. eCollection 2015.

Abstract

Purpose: This study aimed to clarify the prognostic utility of high-sensitivity C-reactive protein (hs-CRP) in nasopharyngeal carcinoma (NPC) patients in the Intensity-Modulated Radiotherapy (IMRT) era.

Patients and methods: In this observational study, 1,589 non-metastatic NPC patients treated with IMRT were recruited. Blood samples were collected before treatment for examination of hs-CRP levels. We evaluated the association of pretreatment hs-CRP levels with overall survival rate (OS), progression free survival rate (PFS), locoregional relapse free survival rate (LRFS) and distant metastasis free survival rate (DMFS).

Results: Baseline hs-CRP levels were correlated with sex, clinical stage, body mass index, smoking status, and EBV DNA level. Multivariate analysis showed that hs-CRP had significant association with OS (HR:1.723; 95%CI:1.238-2.398; p = 0.001), PFS (HR:1.621; 95%CI:1.273-2.064; p<0.001) and DMFS (HR:1.879; 95%CI:1.394-2.531; p<0.001). In subgroups such as advanced-stage group, low EBV DNA group and high EBV DNA group, elevated hs-CRP levels still predicted poor clinical outcomes. Furthermore, in patients with chronic HBV infection, decreased 4-year survival was observed in the cohort of high hs-CRP levels, with 87.4% vs. 94.9% (p = 0.023) for OS, 65.2% vs. 90.8% (p<0.001) for PFS, and 67.6% vs. 95.0% (p<0.001) for DMFS. A similar finding was observed for patients with cardiovascular disease, with 79.1% vs. 90.2% (p = 0.020) for PFS, and 71.4% vs. 97.6% (p = 0.002) for DMFS.

Conclusion: Elevated serum hs-CRP levels were correlated with poor survival for NPC patients in the IMRT era, playing a complementary role to TNM stage and EBV DNA. In addition, elevated hs-CRP level was still an effective indicator for patients with chronic HBV infection and cardiovascular disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • C-Reactive Protein / metabolism*
  • Carcinoma
  • Cisplatin / administration & dosage
  • Disease-Free Survival
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Nasopharyngeal Carcinoma
  • Nasopharyngeal Neoplasms / blood
  • Nasopharyngeal Neoplasms / drug therapy
  • Nasopharyngeal Neoplasms / pathology
  • Nasopharyngeal Neoplasms / radiotherapy*
  • Neoplasm Staging
  • Prognosis
  • Radiotherapy, Intensity-Modulated*
  • Risk Factors

Substances

  • C-Reactive Protein
  • Cisplatin

Grants and funding

This research was supported by grants from the National Natural Science Foundation of China (No: 81072226, http://www.nsfc.gov.cn), the 863 Project (No: 2012AA02A501, http://www.863.gov.cn/), the National Key Basic Research Program of China (No: 2013CB910304, http://www.973.gov.cn), the Sci-Tech Project Foundation of Guangdong Province (No: 2011B080701034, and 2011B031800161, http://www.gdstc.gov.cn/), the Sci-Tech Project Foundation of Guangzhou City (No: 2011J4300100, http://www.gzsi.gov.cn), the Sun Yat-sen University Clinical Research 5010 Program, and the Fundamental Research Funds for the central universities (http://www.sysu.edu.cn). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.