Annals of Surgical Oncology

, Volume 25, Issue 13, pp 3898–3905 | Cite as

C-Reactive Protein Level Predicts Survival Outcomes in Rectal Cancer Patients Undergoing Total Mesorectal Excision After Preoperative Chemoradiation Therapy

  • Woo Ram Kim
  • Yoon Dae Han
  • Byung Soh MinEmail author
Colorectal Cancer



Systemic inflammatory response, as measured by C-reactive protein (CRP), is associated with prognosis in various types of human malignancies. However, to the best of our knowledge, the clinical significance of CRP in patients with locally advanced rectal cancer that undergo preoperative chemoradiation has not been investigated in detail. This retrospective study validates CRP as a potential predictive marker for survival outcomes in rectal cancer patients.


In this study, we enrolled 125 patients that received total mesorectal excision after preoperative chemoradiation for rectal cancer between January 2003 and December 2010. We investigated the association between preoperative CRP and clinicopathological characteristics and assessed the prognostic value of CRP.


The median follow-up was 41 months. Elevated CRP showed significant correlation with high histological grade (P = 0.009) and cancer recurrence (P = 0.027). The 5-year disease-free survival and cancer-specific survival were significantly lower in the elevated CRP group (P = 0.001). Moreover, CRP was the strongest predictive factor for cancer-specific survival in multivariate analysis (P = 0.001). In the subgroup analysis, elevated CRP was a significant prognostic factor in patients with node-positive disease (P = 0.025) and was associated with poorer tumor regression (TRG4–5; P = 0.011).


The results of our study suggest that preoperative CRP level shows prognostic significance in rectal cancer patients that have undergone chemoradiation. Therefore, preoperative CRP may help clinicians to identify patients that need additional therapy to reduce systemic failure.



This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) and funded by the Korea Government (Ministry of Science, ICT and Future Planning, MSIT; Grant No. 2017R1C1B5076797).


The authors declare that they have no conflicts of interest.


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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  1. 1.Department of Surgery, CHA Bundang Medical CenterCHA UniversitySeongnamKorea
  2. 2.Department of SurgeryYonsei University College of Medicine, Yonsei University Health SystemSeoulKorea

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