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Abilities of Pre- and Postoperative High-Sensitivity C-Reactive Protein Levels to Predict 90-Day Mortality After Surgery for Abdominal and Thoracic Cancers

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Elevated high-sensitivity C-reactive protein (hsCRP) levels are known to be associated with a poor prognosis for cancer patients, but inadequate data exist regarding whether pre- or postoperative hsCRP levels have better predictive value after oncologic surgery. This study evaluated the associations between pre- and postoperative hsCRP levels and 90-day postoperative mortality among patients who underwent surgery for abdominal or thoracic cancers.

Methods

This retrospective cohort study included 7933 patients who underwent elective surgery between January 2010 and December 2016. Cox regression analysis and receiver operative characteristic curve analyses were used to evaluate the prognostic values of preoperative hsCRP (< 1 month before surgery) and postoperative hsCRP (< 3 days after surgery).

Results

For predicting 90-day mortality, the area under the receiver operating characteristic curve was significantly larger for preoperative hsCRP than for postoperative hsCRP [0.76; 95% confidence interval (CI) 0.71–0.81 vs 0.65 95% CI 0.57–0.72; P < 0.001]. The optimal cutoff values were 0.5 mg/dL for preoperative hsCRP and 9.7 mg/dL for postoperative hsCRP. Based on these cutoff values, increased risks of 90-day mortality were significantly associated with preoperative hsCRP levels higher than 0.5 mg/dL [hazard ratio (HR) 7.60; 95% CI 4.43–13.03; P < 0.001] and postoperative hsCRP levels higher than > 9.7 mg/dL (HR 1.83; 95% CI 1.12–2.98; P = 0.016).

Conclusion

Both elevated pre- and postoperative hsCRP levels were associated with increased risks of 90-day mortality after surgery for thoracic and abdominal cancer. However, preoperative hsCRP had better prognostic value than postoperative hsCRP.

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Author notes

  1. Tak Kyu Oh and YoungRok Choi made equal contribution as co-first author.

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

    Tak Kyu Oh MD, Ah-Young Oh MD, PhD, Seung Hyun Chung MD, Sunghee Han MD, PhD & Jung-Hee Ryu MD, PhD

  2. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea

    YoungRok Choi MD

  3. Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea

    Ah-Young Oh MD, PhD, Sunghee Han MD, PhD & Jung-Hee Ryu MD, PhD

Authors
  1. Tak Kyu Oh MD
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  2. YoungRok Choi MD
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  3. Ah-Young Oh MD, PhD
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  4. Seung Hyun Chung MD
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  5. Sunghee Han MD, PhD
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Correspondence to Jung-Hee Ryu MD, PhD.

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The authors declare that they have no conflict of interest.

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Oh, T.K., Choi, Y., Oh, AY. et al. Abilities of Pre- and Postoperative High-Sensitivity C-Reactive Protein Levels to Predict 90-Day Mortality After Surgery for Abdominal and Thoracic Cancers. Ann Surg Oncol 25, 3660–3666 (2018). https://doi.org/10.1245/s10434-018-6734-9

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  • DOI: https://doi.org/10.1245/s10434-018-6734-9

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