Tumor Biology

, Volume 36, Issue 11, pp 8465–8470 | Cite as

High pretreatment serum C-reactive protein level predicts a poor prognosis for combined small-cell lung cancer

  • Na Shao
  • Qiling Cai
Research Article


High serum C-reactive protein (CRP) level is related to poor prognosis in several tumors. The aim of this study was to explore the prognosis value of serum CRP in patients with combined small-cell lung cancer (C-SCLC). The clinicopathological parameters of 112 C-SCLC patients from January 2000 to March 2009 were collected. The pretreatment serum CRP level was measured at diagnosis, and the correlation between serum CRP and clinicopathological characters was analyzed. Univariate and multivariate analyses were performed to investigate the prognostic significance of these parameters for C-SCLC. The pretreatment serum CRP level was elevated in 52.7 % of patients (E-CRP; n = 59), while (47.3 %) within the normal range (N-CRP; n = 53). There was a significantly worse disease stage (p = 0.037) and higher neuronal specific enolase (NSE) level (p = 0.014) in the E-CRP group. The median overall survival (OS) was significantly longer in the N-CRP group than in the E-CRP group (22.0 vs. 11.5 months, respectively; p < 0.001). Multivariate analyses indicated serum CRP (hazard ratio (HR) = 2.1; p < 0.001), the extent of disease (HR = 1.3; p = 0.039), performance status (HR = 1.8; p = 0.012), and NSE (HR = 1.2; p < 0.001) as independent prognostic factors. High pretreatment serum CRP level predicts a poor long-term prognosis for C-SCLC, which should be considered in defining the prognosis with other prognosticators in C-SCLC patients.


Combined small-cell lung cancer C-reactive protein Prognosis 


Conflicts of interest


Ethics statement

The study was approved by the Research Ethics Committee of Tianjin Nankai Hospital, China. Written informed consent was obtained from the patients before participating in the study.

Supplementary material

13277_2015_3611_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 21 kb)


  1. 1.
    Adelstein DJ, Tomashefski Jr JF, Snow NJ, Horrigan TP, Hines JD. Mixed small cell and non-small cell lung cancer. Chest. 1986;89:699–704.CrossRefPubMedGoogle Scholar
  2. 2.
    Mangum MD, Greco FA, Hainsworth JD, Hande KR, Johnson DH. Combined small-cell and non-small-cell lung cancer. J Clin Oncol. 1989;7:607–12.CrossRefPubMedGoogle Scholar
  3. 3.
    Nicholson SA, Beasley MB, Brambilla E, Hasleton PS, Colby TV, Sheppard MN, et al. Small cell lung carcinoma (SCLC): a clinicopathologic study of 100 cases with surgical specimens. Am J Surg Pathol. 2002;26:1184–97.CrossRefPubMedGoogle Scholar
  4. 4.
    Zhang J, Qi HW, Zheng H, Chen M, Zhu J, Xie HK, et al. Etoposide-cisplatin alternating with vinorelbine-cisplatin versus etoposide-cisplatin alone in patients with extensive disease combined with small cell lung cancer. Asian Pac J Cancer Prev. 2014;15:4159–63.CrossRefPubMedGoogle Scholar
  5. 5.
    Fushimi H, Kikui M, Morino H, Yamamoto S, Tateishi R, Wada A, et al. Histologic changes in small cell lung carcinoma after treatment. Cancer. 1996;77:278–83.CrossRefPubMedGoogle Scholar
  6. 6.
    Hage R, Elbers JR, Brutel de la Riviere A, van den Bosch JM. Surgery for combined type small cell lung carcinoma. Thorax. 1998;53:450–3.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Weng CT, Chu PY, Liu MT, Chen MK. Small cell carcinoma of the head and neck: a single institution’s experience and review of the literature. J Otolaryngol Head Neck Surg. 2008;37:788–93.PubMedGoogle Scholar
  8. 8.
    Wong YN, Jack RH, Mak V, Henrik M, Davies EA. The epidemiology and survival of extrapulmonary small cell carcinoma in South East England, 1970–2004. BMC Cancer. 2009;9:209.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Radice PA, Matthews MJ, Ihde DC, Gazdar AF, Carney DN, Bunn PA, et al. The clinical behavior of “mixed” small cell/large cell bronchogenic carcinoma compared to “pure” small cell subtypes. Cancer. 1982;50:2894–902.CrossRefPubMedGoogle Scholar
  10. 10.
    Babakoohi S, Fu P, Yang M, Linden PA, Dowlati A. Combined SCLC clinical and pathologic characteristics. Clin Lung Cancer. 2013;14:113–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Mantovani A. Cancer: inflaming metastasis. Nature. 2009;457:36–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Laird BJ, Kaasa S, McMillan DC, Fallon MT, Hjermstad MJ, Fayers P, et al. Prognostic factors in patients with advanced cancer: a comparison of clinicopathological factors and the development of an inflammation-based prognostic system. Clin Cancer Res. 2013;19:5456–64.CrossRefPubMedGoogle Scholar
  13. 13.
    Crumley AB, McMillan DC, McKernan M, McDonald AC, Stuart RC. Evaluation of an inflammation-based prognostic score in patients with inoperable gastro-oesophageal cancer. Br J Cancer. 2006;94:637–41.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Al Murri AM, Bartlett JM, Canney PA, Doughty JC, Wilson C, McMillan DC. Evaluation of an inflammation-based prognostic score (GPS) in patients with metastatic breast cancer. Br J Cancer. 2006;94:227–30.CrossRefPubMedGoogle Scholar
  15. 15.
    McMillan DC. An inflammation-based prognostic score and its role in the nutrition-based management of patients with cancer. Proc Nutr Soc. 2008;67:257–62.CrossRefPubMedGoogle Scholar
  16. 16.
    Hashimoto K, Ikeda Y, Korenaga D, Tanoue K, Hamatake M, Kawasaki K, et al. The impact of preoperative serum C-reactive protein on the prognosis of patients with hepatocellular carcinoma. Cancer. 2005;103:1856–64.CrossRefPubMedGoogle Scholar
  17. 17.
    Crozier JE, McKee RF, McArdle CS, Angerson WJ, Anderson JH, Horgan PG, et al. Preoperative but not postoperative systemic inflammatory response correlates with survival in colorectal cancer. Br J Surg. 2007;94:1028–32.CrossRefPubMedGoogle Scholar
  18. 18.
    Hefler LA, Concin N, Hofstetter G, Marth C, Mustea A, Sehouli J, et al. Serum C-reactive protein as independent prognostic variable in patients with ovarian cancer. Clin Cancer Res. 2008;14:710–4.CrossRefPubMedGoogle Scholar
  19. 19.
    Lee JG, Cho BC, Bae MK, Lee CY, Park IK, Kim DJ, et al. Preoperative C-reactive protein levels are associated with tumor size and lymphovascular invasion in resected non-small cell lung cancer. Lung Cancer. 2009;63:106–10.CrossRefPubMedGoogle Scholar
  20. 20.
    Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.CrossRefGoogle Scholar
  21. 21.
    Kasymjanova G, MacDonald N, Agulnik JS, Cohen V, Pepe C, Kreisman H, et al. The predictive value of pre-treatment inflammatory markers in advanced non-small-cell lung cancer. Curr Oncol. 2010;17:52–8.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Karakiewicz PI, Hutterer GC, Trinh QD, Jeldres C, Perrotte P, Gallina A, et al. C-reactive protein is an informative predictor of renal cell carcinoma-specific mortality: a European study of 313 patients. Cancer. 2007;110:1241–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Shimada H, Nabeya Y, Okazumi S, Matsubara H, Shiratori T, Aoki T, et al. Elevation of preoperative serum C-reactive protein level is related to poor prognosis in esophageal squamous cell carcinoma. J Surg Oncol. 2003;83:248–52.CrossRefPubMedGoogle Scholar
  24. 24.
    Hong S, Kang YA, Cho BC, Kim DJ. Elevated serum C-reactive protein as a prognostic marker in small cell lung cancer. Yonsei Med J. 2012;53:111–7.CrossRefPubMedGoogle Scholar

Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2015

Authors and Affiliations

  1. 1.Department of Respiratory Medicine, Tianjin Hospital of ITCWMNankai HospitalTianjinChina

Personalised recommendations