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Baseline and Postoperative C-reactive Protein Levels Predict Long-Term Survival After Lung Metastasectomy

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

Abstract

Background

Blood level of C-reactive protein (CRP) at diagnosis is a well-know prognostic bio-marker in different primary tumors, but its role has not been investigated in resectable lung metastases. The aim of our study is to assess the predictive value of baseline (CRP0) and 3rd postoperative day (CRP3) levels on long-term survival of patients undergoing lung metastasectomy.

Methods

A total of 846 consecutive patients underwent the first pulmonary resection for lung metastases between January 2003 and December 2015, including 611 (72%) single surgical procedures, 235 (28%) multiple metastasectomies, 501 (59%) epithelial primary tumors, 276 (33%) sarcomas, 66 (8%) melanomas, 286 (33.8%) with 0 risk factors (CRP0 ≤ 2 and CRP3 ≤ 84 mg/L) and 560 (66.2%) with ≥ 1 risk factor (CRP0 > 2 and/or CRP3 > 84 mg/L).

Results

Cumulative 5-year survival was 57% in patients with low CRP (0 risk factors) versus 43% in high CRP (≥ 1 risk factor, p < 0.0002), 62% versus 50% respectively for epithelial tumors (p < 0.0140), and 51% versus 34% for sarcomas (p < 0.0111). Multivariable Cox analysis confirmed a mortality hazard ratio of 2.5 at 1-year and 1.5 at 5-years in patients with high CRP.

Conclusions

Baseline and postoperative CRP levels predict survival of patients with resectable lung metastases. These data provide a rationale for prospective clinical trials testing the efficacy of anti-inflammatory or immune-modulating agents as “adjuvant” therapy after lung metastasectomy, in patients with elevated pre- and/or postoperative CRP levels.

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Authors and Affiliations

  1. Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Ugo Pastorino MD, Giovanni Leuzzi MD, Luigi Rolli MD, Paola Suatoni BS & Elena Bertocchi BL

  2. Biochemical Laboratory, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Daniele Morelli MD

  3. Immuno-Haematology and Transfusion Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Francesca Taverna PhD

  4. Tumour Genomics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Mattia Boeri PhD & Gabriella Sozzi PhD

  5. Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy

    Anna Cantarutti PhD & Giovanni Corrao PhD

  6. Sarcoma Service – Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Alessandro Gronchi MD

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  1. Ugo Pastorino MD
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Correspondence to Ugo Pastorino MD or Alessandro Gronchi MD.

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Fig. 1

Kaplan–Meier survival curves by number of metastasectomy (A. single, B. multiple), according to C-reactive protein measured at baseline (CRP0) and 3 days after surgery (CRP3). Low CRP: CRP0 ≤ 2 and CRP3 ≤ 84-high CRP: CRP0 > 2 or CRP3 > 84 (TIFF 974 kb)

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Pastorino, U., Morelli, D., Leuzzi, G. et al. Baseline and Postoperative C-reactive Protein Levels Predict Long-Term Survival After Lung Metastasectomy. Ann Surg Oncol 26, 869–875 (2019). https://doi.org/10.1245/s10434-018-07116-7

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  • DOI: https://doi.org/10.1245/s10434-018-07116-7

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