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Is C-Reactive Protein a Prognostic Factor of Colorectal Cancer?

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum



C-reactive protein, a commonly used inflammation marker, has been reported to be a prognostic factor of colorectal cancer. This prospective study was designed to confirm the prognostic value of its preoperative levels and to observe their perioperative change.


Between January 2001 and September 2005, preoperative C-reactive protein levels were obtained for 212 consecutive patients (140 males) receiving elective open resection of colorectal cancer. A level higher than 0.5 mg/dl was defined as positive. They were analyzed against clinicopathologic factors. The survival of 158 curative resections was analyzed. Postoperative levels (at months 1, 3, and 6) were collected for analysis of changing trend, from the patients receiving curative surgeries.


Median value of preoperative C-reactive protein was 0.54 mg/dl (48.6 percent positive). Positive rate was significantly correlated with ulcerative type, larger size, higher stage, and positive carcinoembryonic antigen (>5 ng/ml). In both univariate log-rank test and multiple Cox proportional hazards regression, stage (univariate P = 0.011, and multivariate P = 0.016; hazard ratio, 6.23; 95 percent confidence interval, 1.41–27.54), C-reactive protein (0.5 mg/dl; P = 0.005, and P = 0.016; hazard ratio: 6.51; 95 percent confidence interval: 1.41–30.05), and differentiation (P = 0.006, and P = 0.043; hazard ratio, 3.53; 95 percent confidence interval, 1.04–11.98) were significant factors. Analysis of disease-free interval showed C-reactive protein was significant (P = 0.03): as level rose, prognosis worsened. The quiescent inflammation-response group (≤0.1 mg/dl) had excellent outcomes. Postoperatively, the C-reactive protein levels declined at the third postoperative month.


Preoperative C-reactive protein is an independent prognostic factor. The levels declined postoperatively, although with a lag. These findings seem to support the response hypothesis regarding C-reactive protein.

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  1. Coussens LM, Werb Z. Inflammation and cancer. Nature 2002;420:860–7.

    Article  PubMed  CAS  Google Scholar 

  2. Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet 2001;357:539–45.

    Article  PubMed  CAS  Google Scholar 

  3. Gillen CD, Walmsley RS, Prior P, Andrews HA, Allan RN. Ulcerative colitis and Crohn’s disease: a comparison of the colorectal cancer risk in extensive colitis. Gut 1994;35:1590–2.

    Article  PubMed  CAS  Google Scholar 

  4. Baron JA, Cole BF, Sandler RS, et al. A randomized trial of aspirin to prevent colorectal adenomas. N Engl J Med 2003;348:891–9.

    Article  PubMed  CAS  Google Scholar 

  5. Sandler RS, Halabi S, Baron JA, et al. A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. N Engl J Med 2003;348:883–90.

    Article  PubMed  CAS  Google Scholar 

  6. Labayle D, Fischer D, Vielh P, et al. Sulindac causes regression of rectal polyps in familial adenomatous polyposis. Gastroenterology 1991;101:635–9.

    PubMed  CAS  Google Scholar 

  7. Steinbach G, Lynch PM, Phillips RK, et al. The effect of celecoxib, a cyclooxygenase-2 inhibitor, in familial adenomatous polyposis. N Engl J Med 2000;342:1946–52.

    Article  PubMed  CAS  Google Scholar 

  8. Yeh ET. CRP as a mediator of disease. Circulation 2004;109:11–4.

    Article  Google Scholar 

  9. Nozoe T, Matsumata T, Kitamura M, Sugimachi K. Significance of preoperative elevation of serum C-reactive protein as an indicator for prognosis in colorectal cancer. Am J Surg 1998;176:335–8.

    Article  PubMed  CAS  Google Scholar 

  10. Nielsen HJ, Christensen IJ, Sorensen S, Moesgaard F, Brunner N. Preoperative plasma plasminogen activator inhibitor type-1 and serum C-reactive protein levels in patients with colorectal cancer. The RANX05 Colorectal Cancer Study Group. Ann Surg Oncol 2000;7:617–23.

    PubMed  CAS  Google Scholar 

  11. McMillan DC, Canna K, McArdle CS. Systemic inflammatory response predicts survival following curative resection of colorectal cancer. Br J Surg 2003;90:215–9.

    Article  PubMed  CAS  Google Scholar 

  12. Erlinger TP, Platz EA, Rifai N, Helzlsouer KJ. C-reactive protein and the risk of incident colorectal cancer. JAMA 2004;291:585–90.

    Article  PubMed  CAS  Google Scholar 

  13. Siemes C, Visser LE, Coebergh JW, et al. C-reactive protein levels, variation in the C-reactive protein gene, and cancer risk: the Rotterdam Study. J Clin Oncol 2006;24:5216–22.

    Article  PubMed  CAS  Google Scholar 

  14. Hase K, Ueno H, Kuranaga N, Utsunomiya K, Kanabe S, Mochizuki H. Intraperitoneal exfoliated cancer cells in patients with colorectal cancer. Dis Colon Rectum 1998;41:1134–40.

    Article  PubMed  CAS  Google Scholar 

  15. Greene FL, Fleming ID, Fritz AG, Balch CM, Haller DG, Morrow M. AJCC cancer staging manual. 6th ed. Chicago: Springer, 2002.

    Google Scholar 

  16. Compton C, Fenoglio-Preiser CM, Pettigrew N, Fielding LP. American Joint Committee on Cancer Prognostic Factors Consensus Conference: Colorectal Working Group. Cancer 2000;88:1739–57.

    Article  PubMed  CAS  Google Scholar 

  17. Wong VK, Malik HZ, Hamady ZZ, et al. C-reactive protein as a predictor of prognosis following curative resection for colorectal liver metastases. Br J Cancer 2007;96:222–5.

    Article  PubMed  CAS  Google Scholar 

  18. Chung Y-C, Chang Y-F. Serum interleukin-6 levels reflect the disease status of colorectal cancer. J Surg Oncol 2003;83:222–6.

    Article  PubMed  Google Scholar 

  19. Gerhardt T, Milz S, Schepke M, et al. C-reactive protein is a prognostic indicator in patients with perihilar cholangiocarcinoma. World J Gastroenterol 2006;12:5495–500.

    PubMed  CAS  Google Scholar 

  20. Gockel I, Dirksen K, Messow CM, Junginger T. Significance of preoperative C-reactive protein as a parameter of the perioperative course and long-term prognosis in squamous cell carcinoma and adenocarcinoma of the oesophagus. World J Gastroenterol 2006;12:3746–50.

    PubMed  CAS  Google Scholar 

  21. McArdle PA, Mir K, Almushatat AS, Wallace AM, Underwood MA, McMillan DC. Systemic inflammatory response, prostate-specific antigen and survival in patients with metastatic prostate cancer. Urol Int 2006;77:127–9.

    Article  PubMed  CAS  Google Scholar 

  22. Zahlten-Hinguranage A, Goldschmidt H, Cremer FW, et al. Preoperative elevation of serum C-reactive protein is predictive for prognosis in myeloma bone disease after surgery. Br J Cancer 2006;95:782–7.

    Article  PubMed  CAS  Google Scholar 

  23. Nozoe T, Matumata T, Sugimachi K. Preoperative elevation of serum C-reactive protein is related to impaired immunity in patients with colorectal cancer. Am J Clin Oncol 2000;23:263–6.

    PubMed  CAS  Google Scholar 

  24. Canna K, McMillan DC, McNicol AM, et al. The relationship between tumour T-lymphocyte infiltration, the systemic inflammatory response and survival in patients undergoing curative resection for colorectal cancer. Br J Cancer 2005;92:651–4.

    Article  PubMed  CAS  Google Scholar 

  25. 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 2006;66:2483–7.

    Article  PubMed  CAS  Google Scholar 

  26. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest 2003;111:1805–12.

    PubMed  CAS  Google Scholar 

  27. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999;340:448–54.

    Article  PubMed  CAS  Google Scholar 

  28. Kinoshita T, Ito H, Miki C. Serum interleukin-6 level reflects the tumor proliferative activity in patients with colorectal carcinoma. Cancer 1999;85:2526–31.

    Article  PubMed  CAS  Google Scholar 

  29. Pasche B, Serhan CN. Is C-reactive protein an inflammation opsonin that signals colon cancer risk? JAMA 2004;291:623–4.

    Article  PubMed  CAS  Google Scholar 

  30. Chang SC, Lin JK, Yang SH, Jiang JK, Chen WC, Lin TC. Long-term outcome of anastomosis leakage after curative resection for mid and low rectal cancer. Hepatogastroenterology 2003;50:1898–902.

    PubMed  Google Scholar 

  31. Deans C, Rose-Zerilli M, Wigmore S, et al. Host cytokine genotype is related to adverse prognosis and systemic inflammation in gastro-oesophageal cancer. Ann Surg Oncol 2007;14:329–39.

    Article  PubMed  Google Scholar 

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Correspondence to Shung-Haur Yang M.D., Ph.D..

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Supported by Taipei Veterans General Hospital Grant 97.

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Shiu, YC., Lin, JK., Huang, CJ. et al. Is C-Reactive Protein a Prognostic Factor of Colorectal Cancer?. Dis Colon Rectum 51, 443–449 (2008).

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