C-Reactive Protein Is a Negative Independent Factor in Patients with Stage IV Colorectal Cancer Undergoing Oxaliplatin-based Chemotherapy

Background/Aim: To determine the clinical significance of C-reactive protein (CRP) concentration in patients with stage IV colorectal cancer (CRC) undergoing oxaliplatin-based chemotherapy. Patients and Methods: We retrospectively reviewed the medical charts of 112 patients with stage IV CRC who had received modified FOLFOX6 (5- fluorouracil, oxaliplatin, leucovorin) between January 2006, and December 2010 and used Cox's proportional hazard model to determine for independent prognostic factors of survival. We generated receiver operating characteristics (ROC) curves to determine the optimal cut-off for the discrimination of the duration of survival by CRP concentration. Results: According to the multivariate analysis, increased CRP concentration (p=0.04) and non- curative surgery (p<0.01) were independent unfavorable factors for survival, and the optimal cut-off CRP concentration according to dichotomized duration of survival (3-24 months) ranged from 0.8 to 1.2 mg/dl. Conclusion: Pre-chemotherapy CRP concentrations may be useful for predicting survival of patients with stage IV CRC. In absence of a reliable way to predict survival of patients with cancer undergoing chemotherapy, there is continuous interest in identifying prognostic factors that allow fir a more accurate patient stratification and which will contribute to rational study design and analysis (1, 2). The presence of a systemic inflammatory response, as evidenced by increased concentrations of circulating serum C-reactive protein (CRP), is associated with poor survival in patients with colorectal cancer (CRC) who have undergone curative resection (3-7). These responses are thought to be due to infiltration of proinflammatory lymphocytes, cytokines and chemokines into the tumor microenvironment, which predisposes the tumor for further progression, invasion and metastasis (8). Few studies have investigated the relationship between serum (plasma) CRP concentration and survival in patients with stage IV or recurrent CRC (9-12). In addition, the optimal cut-off for discrimination of the duration of survival in patients with such advanced disease by serum CRP concentration has not yet been determined as far as we know. To address these issues, we undertook a retrospective study of patients with stage IV CRC who had undergone oxaliplatin-based chemotherapy (OBC).