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

Ugo Pastorino, Daniele Morelli, Giovanni Leuzzi, Luigi Rolli, Paola Suatoni, Francesca Taverna, Elena Bertocchi, Mattia Boeri, Gabriella Sozzi, Anna Cantarutti, Giovanni Corrao, Alessandro Gronchi

Research output: Contribution to journalArticle

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 (CRP 0 > 2 and/or CRP 3 > 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.

Original languageEnglish
Pages (from-to)869-875
Number of pages7
JournalAnnals of Surgical Oncology
Volume26
Issue number3
DOIs
Publication statusPublished - Mar 15 2019

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Metastasectomy
C-Reactive Protein
Lung
Survival
Neoplasm Metastasis
Sarcoma
Neoplasms
Melanoma
Anti-Inflammatory Agents
Clinical Trials

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Baseline and Postoperative C-reactive Protein Levels Predict Long-Term Survival After Lung Metastasectomy. / Pastorino, Ugo; Morelli, Daniele; Leuzzi, Giovanni; Rolli, Luigi; Suatoni, Paola; Taverna, Francesca; Bertocchi, Elena; Boeri, Mattia; Sozzi, Gabriella; Cantarutti, Anna; Corrao, Giovanni; Gronchi, Alessandro.

In: Annals of Surgical Oncology, Vol. 26, No. 3, 15.03.2019, p. 869-875.

Research output: Contribution to journalArticle

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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 (CRP 0 > 2 and/or CRP 3 > 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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T1 - Baseline and Postoperative C-reactive Protein Levels Predict Long-Term Survival After Lung Metastasectomy

AU - Pastorino, Ugo

AU - Morelli, Daniele

AU - Leuzzi, Giovanni

AU - Rolli, Luigi

AU - Suatoni, Paola

AU - Taverna, Francesca

AU - Bertocchi, Elena

AU - Boeri, Mattia

AU - Sozzi, Gabriella

AU - Cantarutti, Anna

AU - Corrao, Giovanni

AU - Gronchi, Alessandro

PY - 2019/3/15

Y1 - 2019/3/15

N2 - 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 (CRP 0 > 2 and/or CRP 3 > 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.

AB - 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 (CRP 0 > 2 and/or CRP 3 > 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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