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Preoperative plasma plasminogen activator inhibitor type-1 and serum C-reactive protein levels in patients with colorectal cancer

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Abstract

Background: Preoperative plasma plasminogen activator inhibitor-1 (PAI-1) is a prognostic variable in patients with colorectal cancer. It has been suggested, however, that plasma PAI-1 is a nonspecific prognostic parameter similar to the acute-phase reactant C-reactive protein (CRP). In the present study we analyzed the association between plasma PAI-1 and serum CRP in patients scheduled for elective resection of colorectal cancer. In addition, the prognostic value of PAI-1 and CRP was studied in this patient cohort.

Methods: PAI-1 and CRP were analyzed in citrated plasma and serum, respectively, obtained preoperatively from 594 patients. Patients who required preoperative blood transfusion received SAGM blood, in which soluble PAI-1 is not present. None of the patients received pre- or postoperative adjuvant chemotherapy, and all were followed in the outpatient clinic for at least 5 years or until death. The association of PAI-1 and CRP, respectively, with survival was tested using the median value of PAI-1 and the upper normal limit for CRP. Analyses were performed by inclusion of all patients, and in the subgroup of patients, who underwent curative resection.

Results: The median follow-up period was 6.8 (5.4–7.9) years. The median value of plasma PAI-1 was 35.8 ng/ml, and values greater than 94 nmol/L identified patients with increased CRP levels. Comparison of the molecules showed that PAI-1 was weakly correlated with CRP (r=.26;P<.0001). Both molecules showed a Dukes independent distribution. In univariate survival analyses high levels of PAI-1 were found associated with poor prognosis and low levels with good prognosis (P=.02, HR: 1.3). Similarly, high levels of CRP were found associated with poor prognosis and low levels with good prognosis (P<.0001, HR: 1.9). In a multivariate statistical analysis including Dukes classification, gender, age, tumor location, perioperative blood transfusion, PAI-1 and CRP, plasma PAI-1 was a dependent prognostic variable, while serum CRP (P<.0001; HR: 1.4; 95% CI: 1.3–1.5) was found to be a Dukes independent prognostic variable. Similar analyses, excluding patients with Dukes’ D disease showed serum CRP to be an independent prognostic variable (P<.0001; HR: 1.3: 95% CI: 1.2–1.5).

Conclusions: This study did not show a strong correlation between plasma PAI-1 and serum CRP in patients with colorectal cancer. Serum CRP was found to be a Dukes independent prognostic variable in this patient cohort, and was found to identify a subgroup of curatively resected patients at risk for short survival.

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Authors and Affiliations

  1. Department of Clinical Biochemistry, Hvidovre University Hospital, Hvidovre

    Steen Sørensen MD, DMSc

  2. The Finsen Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen

    Ib Jarle Christensen MSc & Nils Brünner MD, DMSc

  3. Dept. of Surgical Gastroenterology 435, Hvidovre University Hospital, DK-2650, Hvidovre, Denmark

    Hans Jørgen Nielsen MD, DMSc & Flemming Moesgaard MD, DMSc

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  1. Hans Jørgen Nielsen MD, DMSc
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  2. Ib Jarle Christensen MSc
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  3. Steen Sørensen MD, DMSc
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  4. Flemming Moesgaard MD, DMSc
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  5. Nils Brünner MD, DMSc
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The RANX05 Colorectal Cancer Study Group

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Correspondence to Hans Jørgen Nielsen MD, DMSc.

Additional information

The study received financial support from The Ingeborg Roikjer Foundation, The Aage and Johanne Louis-Hansen Foundation, The Danish Pharmacy Foundation of 1991, The Agnete and Poul Friis Fund, The Walter and O. Kristiane Christensen Fund, The E. Danielsen Family Fund, The Hede-Nielsen Foundation, The Einar and Vera Hansen Foundation, The Torben and Alice Frimodt Fund, and The Danish Cancer Society (grant # 97 100 21).

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Nielsen, H.J., Christensen, I.J., Sørensen, S. et al. Preoperative plasma plasminogen activator inhibitor type-1 and serum C-reactive protein levels in patients with colorectal cancer. Ann Surg Oncol 7, 617–623 (2000). https://doi.org/10.1007/BF02725342

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  • DOI: https://doi.org/10.1007/BF02725342

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