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Hu JJ, Urbanic JJ, Case LD, Takita C, Wright JL, Brown DR, Langefeld CD, Lively MO, Mitchell SE, Thakrar A, Bryant D, Baglan K, Strasser J, Baez-Diaz L, Lesser GJ, Shaw EG. Association Between Inflammatory Biomarker C-Reactive Protein and Radiotherapy-Induced Early Adverse Skin Reactions in a Multiracial/Ethnic Breast Cancer Population. J Clin Oncol 2018; 36:2473-2482. [PMID: 29989859 DOI: 10.1200/jco.2017.77.1790] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose This study examined an inflammatory biomarker, high-sensitivity C-reactive protein (hsCRP), in radiotherapy (RT)-induced early adverse skin reactions or toxicities in breast cancer. Patients and Methods Between 2011 and 2013, 1,000 patients with breast cancer who underwent RT were evaluated prospectively for skin toxicities through the National Cancer Institute-funded Wake Forest University Community Clinical Oncology Program Research Base. Pre- and post-RT plasma hsCRP levels and Oncology Nursing Society skin toxicity criteria (0 to 6) were used to assess RT-induced skin toxicities. Multivariable logistic regression analyses were applied to ascertain the associations between hsCRP and RT-induced skin toxicities after adjusting for potential confounders. Results The study comprised 623 white, 280 African American, 64 Asian/Pacific Islander, and 33 other race patients; 24% of the patients were Hispanic, and 47% were obese. Approximately 42% and 15% of patients developed RT-induced grade 3+ and 4+ skin toxicities, respectively. The hsCRP levels differed significantly by race and body mass index but not by ethnicity. In multivariable analysis, grade 4+ skin toxicity was significantly associated with obesity (odds ratio [OR], 2.17; 95% CI, 1.41 to 3.34], post-RT hsCRP ≥ 4.11 mg/L (OR, 1.61; 95% CI, 1.07 to 2.44), and both factors combined (OR, 3.65; 95% CI, 2.18 to 6.14). Above-median post-RT hsCRP (OR, 1.93; 95% CI, 1.03 to 3.63), and change in hsCRP (OR, 2.80; 95% CI, 1.42 to 5.54) were significantly associated with grade 4+ skin toxicity in nonobese patients. Conclusion This large prospective study is the first to our knowledge of hsCRP as an inflammatory biomarker in RT-induced skin toxicities in breast cancer. We demonstrate that nonobese patients with elevated RT-related change in hsCRP levels have a significantly increased risk of grade 4+ skin toxicity. The outcomes may help to predict RT responses and guide decision making.
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Affiliation(s)
- Jennifer J Hu
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - James J Urbanic
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - L Doug Case
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Cristiane Takita
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Jean L Wright
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Doris R Brown
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Carl D Langefeld
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Mark O Lively
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Sandra E Mitchell
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Anu Thakrar
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - David Bryant
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Kathy Baglan
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Jon Strasser
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Luis Baez-Diaz
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Glenn J Lesser
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Edward G Shaw
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
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