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Ozoemena OC, Boateng E, Chen A. Ultrasensitive electrochemical immunosensor for the detection of C-reactive protein antigen. Analyst 2024; 149:3773-3782. [PMID: 38845549 DOI: 10.1039/d4an00432a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Cardiovascular disease is one of the leading causes of premature death worldwide, and the determination of C-reactive protein (CRP) from human serum is of vital importance for the diagnosis of the disease. For this study, we have developed an electrochemical immunosensor based on onion-like carbon@polyacrylonitrile (OLC-PAN) for the detection of CRP antigens. This was accomplished by immobilizing CRP antibodies on a modified glassy carbon electrode (GCE). Several electrochemical techniques such as cyclic voltammetry (CV), square wave voltammetry (SWV), and electrochemical impedance spectroscopy (EIS) were employed to evaluate the electrochemical detection of the CRP antigen. This ultrasensitive method for CRP antigen detection exhibited a very good logarithmic plot from -4.52 to -12.05 g mL-1 and a limit of detection (LOD) of 0.9 fg mL-1. The high selectivity, sensitivity, and stability of the developed electrochemical immunosensor would facilitate miniaturization for point-of-care applications and the efficient diagnosis of cardiovascular diseases.
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Affiliation(s)
- Okoroike C Ozoemena
- Electrochemical Technology Centre, Department of Chemistry, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2 W1, Canada.
| | - Emmanuel Boateng
- Electrochemical Technology Centre, Department of Chemistry, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2 W1, Canada.
| | - Aicheng Chen
- Electrochemical Technology Centre, Department of Chemistry, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2 W1, Canada.
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2
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Kubo S, Kobayashi N, Matsumoto H, Somekawa K, Kaneko A, Hashimoto H, Teranishi S, Watanabe K, Horita N, Hara Y, Kudo M, Kaneko T. Atezolizumab addition to platinum doublet: evaluating survival outcomes for patients with extensive disease small cell lung cancer. J Cancer Res Clin Oncol 2023; 149:17419-17426. [PMID: 37878090 DOI: 10.1007/s00432-023-05457-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The efficacy of adding atezolizumab to the platinum doublet regimen for extensive disease small cell lung cancer (ED-SCLC) remains marginally limited. METHODS We retrospectively assessed the real-world efficacy and safety of atezolizumab in addition to carboplatin and etoposide (EP + A), versus carboplatin and etoposide (EP) alone in previously untreated ED-SCLC patients. RESULTS From a total of 99 patients, 46 were assigned to the EP + A group, and 53 to the EP group. No significant difference was observed in progression-free survival between the groups. However, the overall survival (OS) was significantly longer in the EP + A group (20.8 vs 12.1 months; HR: 0.52; p = 0.0127). Patients older than 70 years, male, with performance status 0-1, without liver metastasis, and low levels of C-reactive protein and neutrophil-lymphocyte ratio, experienced longer OS in the EP + A group compared to the EP group. CONCLUSION The addition of atezolizumab to the platinum doublet regimen significantly extended OS in ED-SCLC patients, particularly among certain subgroups, suggesting its potential value in personalized treatment strategies. Further investigation is warranted to validate these findings.
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Affiliation(s)
- Sousuke Kubo
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Nobuaki Kobayashi
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Hiromi Matsumoto
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Kohei Somekawa
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Ayami Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Hisashi Hashimoto
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Shuhei Teranishi
- Respiratory Disease Center, Yokohama City University Medical Center, 4-59 Urafune-Cho, Minami-Ku, Yokohama, Japan
| | - Keisuke Watanabe
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Yu Hara
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Makoto Kudo
- Respiratory Disease Center, Yokohama City University Medical Center, 4-59 Urafune-Cho, Minami-Ku, Yokohama, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
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3
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Mouliou DS. C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians. Diseases 2023; 11:132. [PMID: 37873776 PMCID: PMC10594506 DOI: 10.3390/diseases11040132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
The current literature provides a body of evidence on C-Reactive Protein (CRP) and its potential role in inflammation. However, most pieces of evidence are sparse and controversial. This critical state-of-the-art monography provides all the crucial data on the potential biochemical properties of the protein, along with further evidence on its potential pathobiology, both for its pentameric and monomeric forms, including information for its ligands as well as the possible function of autoantibodies against the protein. Furthermore, the current evidence on its potential utility as a biomarker of various diseases is presented, of all cardiovascular, respiratory, hepatobiliary, gastrointestinal, pancreatic, renal, gynecological, andrological, dental, oral, otorhinolaryngological, ophthalmological, dermatological, musculoskeletal, neurological, mental, splenic, thyroid conditions, as well as infections, autoimmune-supposed conditions and neoplasms, including other possible factors that have been linked with elevated concentrations of that protein. Moreover, data on molecular diagnostics on CRP are discussed, and possible etiologies of false test results are highlighted. Additionally, this review evaluates all current pieces of evidence on CRP and systemic inflammation, and highlights future goals. Finally, a novel diagnostic algorithm to carefully assess the CRP level for a precise diagnosis of a medical condition is illustrated.
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4
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Applications of mass spectroscopy in understanding cancer proteomics. Proteomics 2023. [DOI: 10.1016/b978-0-323-95072-5.00007-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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5
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Yang Y, Xu L, Sun L, Zhang P, Farid SS. Machine learning application in personalised lung cancer recurrence and survivability prediction. Comput Struct Biotechnol J 2022; 20:1811-1820. [PMID: 35521553 PMCID: PMC9043969 DOI: 10.1016/j.csbj.2022.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 12/24/2022] Open
Abstract
Machine learning is an important artificial intelligence technique that is widely applied in cancer diagnosis and detection. More recently, with the rise of personalised and precision medicine, there is a growing trend towards machine learning applications for prognosis prediction. However, to date, building reliable prediction models of cancer outcomes in everyday clinical practice is still a hurdle. In this work, we integrate genomic, clinical and demographic data of lung adenocarcinoma (LUAD) and squamous cell carcinoma (LUSC) patients from The Cancer Genome Atlas (TCGA) and introduce copy number variation (CNV) and mutation information of 15 selected genes to generate predictive models for recurrence and survivability. We compare the accuracy and benefits of three well-established machine learning algorithms: decision tree methods, neural networks and support vector machines. Although the accuracy of predictive models using the decision tree method has no significant advantage, the tree models reveal the most important predictors among genomic information (e.g. KRAS, EGFR, TP53), clinical status (e.g. TNM stage and radiotherapy) and demographics (e.g. age and gender) and how they influence the prediction of recurrence and survivability for both early stage LUAD and LUSC. The machine learning models have the potential to help clinicians to make personalised decisions on aspects such as follow-up timeline and to assist with personalised planning of future social care needs.
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Saad MR, Han HS, Yoon YS, Cho JY, Lee JS, Shehta A. Impact of Acute Inflammation on the Survival Outcomes of Patients with Resected Pancreatic Ductal Adenocarcinoma. Dig Surg 2021; 38:343-351. [PMID: 34731855 DOI: 10.1159/000520063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/30/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The impact of acute inflammation on cancer progression is still not well elucidated. Pancreatic head cancer is occasionally associated with acute cholangitis. C-reactive protein (CRP) is a biomarker that indicates presence of acute inflammation. METHODS We reviewed the patients' data with pancreatic ductal adenocarcinoma (PDAC) who underwent pancreaticoduodenectomy between 2004 and 2018. RESULTS Two hundred ninety-one patients were included. Median preoperative CRP was 0.45 mg/dL (0-18.9). Median follow-up duration was 22 months (4-152). The 1-, 3-, and 5-year overall survival (OS) rates were 76.4%, 32.2%, and 22.9%, respectively. Recurrence occurred in 168 cases (57.7%). The 1-, 3-, and 5-year disease-free survival (DFS) rates were 53.9%, 27.1%, and 21.9%, respectively. The median OS was higher in normal CRP patients (27 months) than those with elevated CRP (18 months) (log-rank 0.038). The median DFS was higher in normal CRP patients (17 months) than those with elevated CRP (9 months) (log-rank < 0.001). Predictive factors for OS included BMI, CRP, adjuvant therapy, positive lymph nodes, and microvascular invasion. Predictive factors for DFS included CRP, positive lymph nodes, and microvascular invasion. CONCLUSION Preoperative CRP was an independent poor prognostic factor for OS and DFS of patients with resected PDAC.
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Affiliation(s)
- Mohamed Rabie Saad
- Department of Surgery, Faculty of Medicine, Aswan University Hospital, Aswan, Egypt.,Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Suh Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ahmed Shehta
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea, .,Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt,
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BULUT S, ÇELİK D. THE EFFECTS OF TUMOR LOCALIZATION ON SMALL CELL LUNG CANCER AND ITS ASSOCIATION WITH PROGNOSIS. ACTA MEDICA ALANYA 2021. [DOI: 10.30565/medalanya.969705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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AKINCI ÖZYÜREK B, YENİBERTİZ D, GÜRÜN KAYA A, USLU BİNER İ, BÜYÜKYAYLACI ÖZDEN S, ERDOĞAN Y. The role of the C-reactive protein/albumin ratio in determining prognosis of patients diagnosed with small cell lung cancer and the relationship with the diameter and suvmax value of primer mass in PET-CT. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2020. [DOI: 10.32322/jhsm.778080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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9
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Liu F, Zhou S, Tan L, Jiang H, Huang Y. A Retrospective Cohort Study on Pretreated Neutrophil-to-Lymphocyte Ratio and Prognosis of Small Cell Lung Cancer: Evidence of Effect Modification by Chemotherapy Regimen. Cancer Manag Res 2020; 12:10341-10352. [PMID: 33116889 PMCID: PMC7586078 DOI: 10.2147/cmar.s263863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/31/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose Neutrophil-to-lymphocyte ratio (NLR) has been suggested as an independent risk factor for progression-free survival (PFS) and overall survival (OS) in small cell lung cancer (SCLC). However, it is still unknown whether there is a linear relationship between the NLR and the risk of death in SCLC. The objective of this study is to provide further results. Patients and Methods A retrospective cohort study was performed among a total of 251 participants with SCLC. Smooth curve fitting and piecewise Cox regression model were used to determine the linear relationship between NLR and mortality risk. A multivariable Cox regression model was used to estimate the effects of NLR on OS. Interaction and stratified analyses were conducted according to covariates. Results The analysis indicated no significant nonlinear relationship or threshold effect between NLR and hazard of death. Multivariate analysis revealed that every unit increase in NLR was associated with a 10% increase in mortality risk. High NLR (>3.5) at baseline was associated with poor OS (hazard ratio [HR]=1.97, P=0.009). The difference in median OS duration between the high and low NLR groups was statistically significant (9.1 months vs 14.6 months, P=0.0067). Furthermore, interaction analysis identified the chemotherapy regimen to play an interactive role in the association between NLR and hazard of death. Conclusion NLR was identified as an independent risk factor for OS in SCLC and the linear correlation was observed between them. Administration of etoposide plus cisplatin (EP) regimen in patients with low NLR resulted in better long-term outcome than that of etoposide plus carboplatin (EC) regimen, while administration of the EC regimen conferred longer OS than that of the EP regimen in patients with high NLR.
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Affiliation(s)
- Feiwen Liu
- Oncology Medical College, Guangxi Medical University, Nanning City 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Shaozhang Zhou
- Oncology Medical College, Guangxi Medical University, Nanning City 530021, Guangxi Zhuang Autonomous Region, People's Republic of China.,Department of Respiratory Oncology, Guangxi Medical University Affiliated Tumor Hospital, Nanning City 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Liping Tan
- Department of Respiratory Oncology, Guangxi Medical University Affiliated Tumor Hospital, Nanning City 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Huiqin Jiang
- Oncology Medical College, Guangxi Medical University, Nanning City 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Yucong Huang
- Oncology Medical College, Guangxi Medical University, Nanning City 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
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10
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C-reactive protein gene 1846C>T polymorphism is associated with increased risk and clinical features of lung cancer: a case-control study. Biosci Rep 2019; 39:BSR20181936. [PMID: 31142628 PMCID: PMC6616045 DOI: 10.1042/bsr20181936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/18/2019] [Accepted: 05/23/2019] [Indexed: 12/13/2022] Open
Abstract
Chronic inflammation plays an important role in lung carcinogenesis. Recently, several studies investigated the association of C-reactive protein (CRP) gene 1846C>T polymorphism and lung cancer (LC) risk, but with conflicting findings. In the present study, we conducted this case-control study with 408 LC patients and 472 healthy controls in a Chinese Han population. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLR) method. Our data found that CRP gene 1846C>T polymorphism increased the risk of LC. Subgroup analyses obtained significant associations among the groups of males, ≥50 years old, smoking, and non-drinkers. Bioinformatics analysis showed that the expression levels of CRP in LC tissues were significantly increased compared with normal tissues. Additionally, the present study found CRP mRNA high expression was associated with worse survival in LC patients. Furthermore, our data indicated that TT genotype of 1846C>T polymorphism was associated with a larger size of tumor and was related with lymphatic metastasis in LC patients. In conclusion, the present study suggests that CRP gene 1846C>T polymorphism is associated with increased risk of LC. CRP gene 1846C>T polymorphism may be a potential marker for the diagnosis of LC.
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11
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Zhou T, Zhao Y, Zhao S, Yang Y, Huang Y, Hou X, Zhao H, Zhang L. Comparison of the Prognostic Value of Systemic Inflammation Response Markers in Small Cell Lung Cancer Patients. J Cancer 2019; 10:1685-1692. [PMID: 31205524 PMCID: PMC6547997 DOI: 10.7150/jca.29319] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 01/12/2019] [Indexed: 02/07/2023] Open
Abstract
Increasing evidences support that systemic inflammation-based prognostic scores, modified Glasgow Prognostic Score (mGPS), C-reactive Protein/Albumin (CRP/ALB), Albumin/Globulin (AGR), Prognostic Nutritional Index (PNI) and Advanced Lung cancer Inflammation index (ALI), are key determinants of patients' outcome in solid tumors. However, in small cell lung cancer (SCLC), there have been no direct comparisons of them. Thus, the aim of this study was to compare the prognostic value of these markers in SCLC, and select a most appropriative one. The patients with confirmed SCLC were screened between 2006 and 2011, and inflammation-based prognostic factors (mGPS, CRP/ALB, AGR, PNI, ALI) were examined. Kaplan-Meier and Cox regression analysis were performed to assess these inflammation-based prognostic scores associated with overall survival (OS). Subsequently, we compared the prognostic value of these inflammation-based prognostic scores using the area under the curve (AUC). In 451 patients, on univariate analysis, mGPS (P<0.001), CRP/ALB (P<0.001), AGR (P<0.001), PNI (P<0.001) and ALI (P<0.001) were the strongest predictors of OS. Further multivariate analysis confirmed mGPS (P<0.001), CRP/ALB (P=0.007), AGR (P=0.034) and PNI (P=0.026) as independent markers associated with OS. Further subgroup analysis revealed CRP/ALB was able to predict outcome in both limited (P=0.005) and extensive disease (P=0.013). The CRP/ALB had higher AUC values compared with other inflammation-based prognostic socres (0.566). The CRP/ALB was characterized as best, in comparison to other systemic inflammation-based prognostic scores, for its predictive power of SCLC patients' survival, and had the potential to be hierarchical factor in future clinical trials.
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Affiliation(s)
- Ting Zhou
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yuanyang Zhao
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Shen Zhao
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yunpeng Yang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yan Huang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Xue Hou
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Hongyun Zhao
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative innovation Center for Cancer Medicine, Guangzhou 510060, China
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12
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Hamid UI, Al-Saudi R, Paul I, Graham A. Role of preoperative blood markers as prognostic factors for lung cancer surgery. Asian Cardiovasc Thorac Ann 2019; 27:288-293. [PMID: 30832488 DOI: 10.1177/0218492319834812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study was undertaken to assess the potential value of preoperative blood components as prognostic markers of outcome after lung cancer resection, and hence their potential to aid in the selection of patients for curative surgery. METHODS This was a single-center study on 313 patients who underwent surgery for non-small-cell lung cancer from 2006 to 2008. Data were analyzed retrospectively from a prospectively maintained thoracic database. Preoperative blood results including plasma fibrinogen levels, serum C-reactive protein, hemoglobin concentration, and platelet count were included in the analysis. RESULTS The mean age was 75 years, and 40% of the patients were females. The most common resection was lobectomy in 68% of patients, followed by pneumonectomy, wedge resection, and segmentectomy in 18%, 10%, and 1.6%, respectively. Patients with abnormal C-reactive protein, fibrinogen, and hemoglobin levels had a worse overall survival. Large tumor size and nodal metastasis on clinical staging was also associated with poor survival. However, on Cox regression analysis, plasma fibrinogen and nodal metastasis were the only independent predictors of survival after lung resection. CONCLUSIONS Among the different blood markers, elevated preoperative plasma fibrinogen was an independent marker of reduced survival in patients with resected non-small-cell lung cancer, and its value in selecting patients who may benefit from surgery needs further investigation.
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Affiliation(s)
- Umar Imran Hamid
- Department of Cardiothoracic surgery, Royal Victoria Hospital, Belfast, UK
| | - Reza Al-Saudi
- Department of Cardiothoracic surgery, Royal Victoria Hospital, Belfast, UK
| | - Ian Paul
- Department of Cardiothoracic surgery, Royal Victoria Hospital, Belfast, UK
| | - Alastair Graham
- Department of Cardiothoracic surgery, Royal Victoria Hospital, Belfast, UK
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Yu JM, Yang M, Xu HX, Li W, Fu ZM, Lin Y, Shi YY, Song CH, Shi HP, Guo ZQ. Association Between Serum C-Reactive Protein Concentration and Nutritional Status of Malignant Tumor Patients. Nutr Cancer 2018; 71:240-245. [PMID: 30450976 DOI: 10.1080/01635581.2018.1524019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Jia Mi Yu
- Department of Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China
| | - Mei Yang
- Department of Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China
| | - Hong Xia Xu
- Department of Nutrition, Daping Hospital & Research Institute of Surgery, Third Military Medical University, Chongqing, China
| | - Wei Li
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhen Ming Fu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yuan Lin
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ying Ying Shi
- Department of Surgery, The First Affiliated Hospital of SunYat-sen University, Guangzhou, Guangdong, China
| | - Chun Hua Song
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Han Ping Shi
- Department of Gastrointestinal Surgery/Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Zeng Qing Guo
- Department of Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China
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14
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Sonuç Karaboğa MN, Sezgintürk MK. Determination of C-reactive protein by PAMAM decorated ITO based disposable biosensing system: A new immunosensor design from an old molecule. Talanta 2018; 186:162-168. [DOI: 10.1016/j.talanta.2018.04.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 12/18/2022]
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15
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Huang R, Chen Z, He L, He N, Xi Z, Li Z, Deng Y, Zeng X. Mass spectrometry-assisted gel-based proteomics in cancer biomarker discovery: approaches and application. Theranostics 2017; 7:3559-3572. [PMID: 28912895 PMCID: PMC5596443 DOI: 10.7150/thno.20797] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 07/12/2017] [Indexed: 12/13/2022] Open
Abstract
There is a critical need for the discovery of novel biomarkers for early detection and targeted therapy of cancer, a major cause of deaths worldwide. In this respect, proteomic technologies, such as mass spectrometry (MS), enable the identification of pathologically significant proteins in various types of samples. MS is capable of high-throughput profiling of complex biological samples including blood, tissues, urine, milk, and cells. MS-assisted proteomics has contributed to the development of cancer biomarkers that may form the foundation for new clinical tests. It can also aid in elucidating the molecular mechanisms underlying cancer. In this review, we discuss MS principles and instrumentation as well as approaches in MS-based proteomics, which have been employed in the development of potential biomarkers. Furthermore, the challenges in validation of MS biomarkers for their use in clinical practice are also reviewed.
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Affiliation(s)
- Rongrong Huang
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
| | - Zhongsi Chen
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
| | - Lei He
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
| | - Nongyue He
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
- Economical Forest Cultivation and Utilization of 2011 Collaborative Innovation Center in Hunan Province, Hunan Key Laboratory of Green Chemistry and Application of Biological Nanotechnology; Hunan University of Technology, Zhuzhou 412007, China
| | - Zhijiang Xi
- School of Medicine, Yangtze University, Jingzhou 434023, China
| | - Zhiyang Li
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
- Department of Clinical Laboratory, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Yan Deng
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
- Economical Forest Cultivation and Utilization of 2011 Collaborative Innovation Center in Hunan Province, Hunan Key Laboratory of Green Chemistry and Application of Biological Nanotechnology; Hunan University of Technology, Zhuzhou 412007, China
| | - Xin Zeng
- Nanjing Maternity and Child Health Medical Institute, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing 210004, China
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Rajopadhye SH, Mukherjee SR, Chowdhary AS, Dandekar SP. Oxidative Stress Markers in Tuberculosis and HIV/TB Co-Infection. J Clin Diagn Res 2017; 11:BC24-BC28. [PMID: 28969114 DOI: 10.7860/jcdr/2017/28478.10473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/29/2017] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Dysfunction of redox homeostasis has been implicated in many pathological conditions. An imbalance of pro- and anti-oxidants have been observed in Tuberculosis (TB) and its co-morbidities especially HIV/AIDS. The pro inflammatory milieu in either condition aggravates the physiological balance of the redox mechanisms. The present study therefore focuses on assessing the redox status of patients suffering from TB and HIV-TB co-infection. AIM To assess the oxidative stress markers in the HIV-TB and TB study cohort. MATERIALS AND METHODS The current prospective study was conducted in Haffkine Institute, Parel, Maharashtra, India, during January 2013 to December 2015. Blood samples from 50 patients each suffering from active TB and HIV-TB co-infection were collected from Seth G.S.Medical College and KEM Hospital Mumbai and Group of Tuberculosis Hospital, Sewree Mumbai. Samples were processed and the experiments were carried out at the Department of Biochemistry, Haffkine Institute. Samples from 50 healthy volunteers were used as controls. Serum was assessed for pro-oxidant markers such as Nitric Oxide (NO), Thiobarbituric Acid Reactive Species (TBARS), C-Reactive Protein (CRP), superoxide anion. Antioxidant markers such as catalase and Superoxide Dismutase (SOD) were assessed. Total serum protein, was also assessed. RESULTS Among the pro-oxidants, serum NO levels were decreased in TB group while no change was seen in HIV-TB group. TBARS and CRP levels showed significant increase in both groups; superoxide anion increased significantly in HIV-TB group. Catalase levels showed decreased activities in TB group. SOD activity significantly increased in HIV-TB but not in TB group. The total serum proteins were significantly increased in HIV-TB and TB groups. The values of Control cohort were with the normal reference ranges. CONCLUSION In the present study, we found the presence of oxidative stress to be profound in the TB and HIV-TB co-infection population.
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Affiliation(s)
- Shreewardhan Haribhau Rajopadhye
- PhD Fellow, Department of Biochemistry, Seth G.S. Medical College and KEM Hospital and Department of Biochemistry, Haffkine Institute, Parel, Mumbai, Maharashtra, India
| | - Sandeepan R Mukherjee
- Scientific Officer, Department of Virology and Immunology, Haffkine Institute, Parel, Mumbai, Maharashtra, India
| | - Abhay S Chowdhary
- Professor and Head, Department of Microbiology, GGMC and Sir J.J. Group of Hospitals, Mumbai, Maharashtra, India
| | - Sucheta P Dandekar
- Professor and Head, Department of Biochemistry, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
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C-reactive protein-to-albumin ratio is a predictor of hepatitis B virus related decompensated cirrhosis: time-dependent receiver operating characteristics and decision curve analysis. Eur J Gastroenterol Hepatol 2017; 29:472-480. [PMID: 27984322 DOI: 10.1097/meg.0000000000000807] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Hepatitis B virus (HBV) infection remains a major health problem and HBV-related-decompensated cirrhosis (HBV-DC) usually leads to a poor prognosis. Our aim was to determine the utility of inflammatory biomarkers in predicting mortality of HBV-DC. MATERIALS AND METHODS A total of 329 HBV-DC patients were enrolled. Survival estimates for the entire study population were generated using the Kaplan-Meier method. The prognostic values for model for end-stage liver disease (MELD) score, Child-Pugh score, and inflammatory biomarkers neutrophil/lymphocyte ratio, C-reactive protein-to-albumin ratio (CAR), and lymphocyte-to-monocyte ratio (LMR) for HBV-DC were compared using time-dependent receiver operating characteristic curves and time-dependent decision curves. RESULTS The survival time was 23.1±15.8 months. Multivariate analysis identified age, CAR, LMR, and platelet count as prognostic independent risk factors. Kaplan-Meier analysis indicated that CAR of at least 1.0 (hazard ratio, 7.19; 95% confidence interval, 4.69-11.03), and LMR less than 1.9 (hazard ratio, 2.40; 95% confidence interval, 1.69-3.41) were independently associated with mortality of HBV-DC. The time-dependent receiver operating characteristic indicated that CAR showed the best performance in predicting mortality of HBV-DC compared with LMR, MELD score, and Child-Pugh score. The results were also confirmed by time-dependent decision curves. CONCLUSION CAR and LMR were associated with the prognosis of HBV-DC. CAR was superior to LMR, MELD score, and Child-Pugh score in HBV-DC mortality prediction.
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Abstract
Precision medicine relies on validated biomarkers with which to better classify patients by their probable disease risk, prognosis and/or response to treatment. Although affordable 'omics'-based technology has enabled faster identification of putative biomarkers, the validation of biomarkers is still stymied by low statistical power and poor reproducibility of results. This Review summarizes the successes and challenges of using different types of molecule as biomarkers, using lung cancer as a key illustrative example. Efforts at the national level of several countries to tie molecular measurement of samples to patient data via electronic medical records are the future of precision medicine research.
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Affiliation(s)
- Ashley J Vargas
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Room 3068A, MSC 425, 837 Convent Drive, Bethesda, Maryland 20892-4258, USA
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland 20850, USA
| | - Curtis C Harris
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Room 3068A, MSC 425, 837 Convent Drive, Bethesda, Maryland 20892-4258, USA
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Zhang ZD, Li X, Lu C. Prognostic value of C-reactive protein in patients with colorectal cancer: Meta-analysis. Shijie Huaren Xiaohua Zazhi 2016; 24:2093-2101. [DOI: 10.11569/wcjd.v24.i13.2093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the association between prognosis and C-reactive protein (CRP) in patients with colorectal cancer.
METHODS: We systematically searched the relevant studies assessing prognostic value of C-reactive protein in patients with colorectal cancer in PubMed and Embase database (up to May 2015). This meta-analysis was completed with hazard ratio (HR) and 95% confidence intervals (CI) as effect measures, using Stata12.0 software. Subgroup and sensitivity analyses were also performed.
RESULTS: Twenty-one eligible studies were included in the present meta-analysis, including 4242 patients with colorectal cancer. Our results showed that elevated CRP was associated with poor survival in patients with colorectal cancer (overall survival: HR = 1.89, 95%CI: 1.52-2.35, P < 0.001; cancer-specific survival: HR = 2.08, 95%CI: 1.42-3.04, P < 0.001; disease-free survival: HR = 1.44, 95%CI: 1.25-1.67, P < 0.001). The subgroup analyses based on the sampling time, sample size and study region obtained similar results. Moreover, sensitivity analyses confirmed the stability of our results.
CONCLUSION: Our meta-analysis indicates that CRP is significantly associated with a poor prognosis for patients with colorectal cancer.
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Minami S, Ogata Y, Ihara S, Yamamoto S, Komuta K. Retrospective analysis of outcomes and prognostic factors of chemotherapy for small-cell lung cancer. LUNG CANCER (AUCKLAND, N.Z.) 2016; 7:35-44. [PMID: 28210159 PMCID: PMC5310697 DOI: 10.2147/lctt.s100184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Small-cell lung cancer (SCLC) is responsive to initial chemotherapy but becomes resistant to cytotoxic drugs. The aim of this study was to evaluate what proportion of patients with SCLC had received the first- and further-line chemotherapy and which patients had benefited from chemotherapy. METHODS We retrospectively reviewed medical records of patients with SCLC who had been treated with the best supportive care alone and the first-, second-, or third-line chemotherapy at the Osaka Police Hospital from June 2007 until March 2015. RESULTS Among 145 patients diagnosed with SCLC and eligible for analysis, 118 patients received chemotherapy. We added five patients who initiated the second-line chemotherapy during the study period at our institution. Sixty-five and 31 patients received the second- and third-line chemotherapies, respectively. Multivariate logistic regression analysis detected age ≥75 years (odds ratio, 2.80; 95% confidence interval, 1.01-7.75; P=0.047) and European Clinical Oncology Group Performance Status (ECOG PS) 3-4 (14.3; 4.86-41.9; P<0.01) as factors disturbing the introduction of chemotherapy. Multivariate Cox hazard analyses also detected ECOG PS 2-4 (3.34; 2.00-5.58; P<0.01) as a factor decreasing overall survival after the first-line chemotherapy, and C-reactive protein level ≥1.0 mg/dL (2.67; 1.30-5.47; P<0.01) and progression-free survival after the first-line chemotherapy ≥6 months (2.85; 1.50-5.43; P<0.01) as factors influencing overall survival after the second-line chemotherapy. CONCLUSION Approximately two-thirds and one-third of the patients who receive chemotherapy proceed to the second- and third-line chemotherapies, respectively. Several factors, such as age, ECOG PS, C-reactive protein level, and progression-free survival after previous treatment may be useful when considering the introduction of further-line chemotherapy.
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Affiliation(s)
- Seigo Minami
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | - Yoshitaka Ogata
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | - Shouichi Ihara
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | - Suguru Yamamoto
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | - Kiyoshi Komuta
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
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Metgud R, Bajaj S. Altered serum and salivary C-reactive protein levels in patients with oral premalignant lesions and oral squamous cell carcinoma. Biotech Histochem 2015; 91:96-101. [PMID: 26529498 DOI: 10.3109/10520295.2015.1077393] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chronic inflammation is associated with cancer development. C-reactive protein (CRP), an acute phase protein synthesized primarily in the liver, is a marker for inflammation and for the progression of many cancers. We compared serum and salivary CRP levels in 20 normal individuals, 20 patients with oral premalignant lesions and 20 patients with oral squamous cell carcinoma (OSCC) to assess its efficacy as a prognostic indicator for OSCC. Saliva and blood samples were obtained and evaluated for CRP levels. Mean CRP levels were higher in patients with oral premalignant lesions compared to controls. CRP levels in OSCC patients were elevated and were associated with advanced tumor stages.
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Affiliation(s)
- R Metgud
- a Department of Oral and Maxillofacial Pathology , Pacific Dental College and Hospital, Paher University , Udaipur , India
| | - S Bajaj
- a Department of Oral and Maxillofacial Pathology , Pacific Dental College and Hospital, Paher University , Udaipur , India
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Shao N, Cai Q. High pretreatment neutrophil-lymphocyte ratio predicts recurrence and poor prognosis for combined small cell lung cancer. Clin Transl Oncol 2015; 17:772-8. [PMID: 26243392 DOI: 10.1007/s12094-015-1289-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/08/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUNDS Compared to pure small cell lung cancer (SCLC), combined small cell lung cancer (C-SCLC) has its own characteristics. High neutrophil to lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have been shown to be related to poor prognosis in several types of tumors. The aim of this study was to explore the prognosis value of NLR and PLR in patients with C-SCLC. METHODS A total of 112 patients diagnosed with C-SCLC between January 2000 and March 2009 were enrolled in the study. The clinicopathological parameters, laboratory analyses, and survival time were collected and analyzed. The correlation between NLR, PLR, and clinicopathological characters was analyzed. Univariate and multivariate analyses were performed to investigate the prognostic significance of these parameters for C-SCLC. RESULTS The pretreatment NLR was elevated in 37.5 % patients (NLR ≥ 4.15; n = 42; H-NLR). NLR was significantly related to disease stage (p = 0.033) and tumor recurrence (p = 0.014). The median overall survival (OS) and progression-free survival (PFS) were significantly worse in the H-NLR group (OS: 22.0 months vs 11.7 months, p = 0.001; PFS: 11.1 vs 6.0 months, p < 0.001). However, PLR at diagnosis was not associated with OS or PFS. Multivariate analyses indicated elevated NLR (HR = 1.6; p = 0.001), disease stage (HR = 1.6; p = 0.001), and performance status (HR = 1.8; p = 0.015) as independent prognostic factors. CONCLUSIONS High pretreatment NLR (≥4.15) is a potential useful indicator for C-SCLC recurrence and predicts a poor long-term prognosis for C-SCLC, which should be considered in defining the prognosis with other well-known prognosticators in C-SCLC patients.
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Affiliation(s)
- N Shao
- Department of Respiratory Medicine, Tianjin Hospital of ITCWM, Nankai Hospital, Changjiang Road, Nankai District, Tianjin, 300100, China.
| | - Q Cai
- Department of Respiratory Medicine, Tianjin Hospital of ITCWM, Nankai Hospital, Changjiang Road, Nankai District, Tianjin, 300100, China
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Zhou T, Zhan J, Hong S, Hu Z, Fang W, Qin T, Ma Y, Yang Y, He X, Zhao Y, Huang Y, Zhao H, Zhang L. Ratio of C-Reactive Protein/Albumin is An Inflammatory Prognostic Score for Predicting Overall Survival of Patients with Small-cell Lung Cancer. Sci Rep 2015; 5:10481. [PMID: 26084991 PMCID: PMC4471724 DOI: 10.1038/srep10481] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/15/2015] [Indexed: 12/22/2022] Open
Abstract
Recent studies have indicated that the C-reactive protein/ albumin (CRP/Alb) ratio is associated with clinical outcomes in patients with hepatocellular carcinoma (HCC). We examined the prognostic value of this ratio in patients with small-cell lung cancer (SCLC). In this retrospective study, a total of 367 eligible SCLC patients were analyzed and the correlation between the pretreatment CRP/Alb ratio and overall survival (OS) was investigated. The optimal cutoff level of CRP/Alb ratio was at 0.441. A low and high CRP/Alb ratio was assigned to 65.1% and 34.9% of patients, respectively. The median OS of patients with a high CRP/Alb ratio was worse than those in the low group (13.70 vs 18.90 months HR, 1.34; p = 0.005). Disease stage (p < 0.001), performance status (PS) (p < 0.001) and pretreatment LDH (p < 0.001) were also significant predictors of OS. Multivariate analyses showed that the CRP/Alb ratio is an independent prognostic factor (p = 0.025). This study demonstrated that the CRP/Alb ratio could independently predict OS in patients with SCLC, and had comparable prognostic value to other known prognostic markers. Therefore, the CRP/Alb ratio could have prognostic value and be a measurable biomarker in patients with SCLC.
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Affiliation(s)
- Ting Zhou
- 1] Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China [2] State Key Laboratory of Oncology in South China, Guangzhou, China [3] Collaborative innovation Center for Cancer Medicine, Guangzhou, China
| | - Jianhua Zhan
- 1] Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China [2] State Key Laboratory of Oncology in South China, Guangzhou, China [3] Collaborative innovation Center for Cancer Medicine, Guangzhou, China
| | - Shaodong Hong
- 1] Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China [2] State Key Laboratory of Oncology in South China, Guangzhou, China [3] Collaborative innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhihuang Hu
- 1] Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China [2] State Key Laboratory of Oncology in South China, Guangzhou, China [3] Collaborative innovation Center for Cancer Medicine, Guangzhou, China
| | - Wenfeng Fang
- 1] Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China [2] State Key Laboratory of Oncology in South China, Guangzhou, China [3] Collaborative innovation Center for Cancer Medicine, Guangzhou, China
| | - Tao Qin
- 1] Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China [2] State Key Laboratory of Oncology in South China, Guangzhou, China [3] Collaborative innovation Center for Cancer Medicine, Guangzhou, China
| | - Yuxiang Ma
- 1] Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China [2] State Key Laboratory of Oncology in South China, Guangzhou, China [3] Collaborative innovation Center for Cancer Medicine, Guangzhou, China
| | - Yunpeng Yang
- 1] Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China [2] State Key Laboratory of Oncology in South China, Guangzhou, China [3] Collaborative innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiaobo He
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yuanyuan Zhao
- 1] Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China [2] State Key Laboratory of Oncology in South China, Guangzhou, China [3] Collaborative innovation Center for Cancer Medicine, Guangzhou, China
| | - Yan Huang
- 1] Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China [2] State Key Laboratory of Oncology in South China, Guangzhou, China [3] Collaborative innovation Center for Cancer Medicine, Guangzhou, China
| | - Hongyun Zhao
- 1] Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China [2] State Key Laboratory of Oncology in South China, Guangzhou, China [3] Collaborative innovation Center for Cancer Medicine, Guangzhou, China
| | - Li Zhang
- 1] Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China [2] State Key Laboratory of Oncology in South China, Guangzhou, China [3] Collaborative innovation Center for Cancer Medicine, Guangzhou, China
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Shao N, Cai Q. High pretreatment serum C-reactive protein level predicts a poor prognosis for combined small-cell lung cancer. Tumour Biol 2015; 36:8465-70. [DOI: 10.1007/s13277-015-3611-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 05/22/2015] [Indexed: 01/21/2023] Open
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Procalcitonin Is Not Useful to Discriminate Between Infectious and Noninfectious CRP Elevation in Patients with Non-Small Cell Lung Cancer. Infect Control Hosp Epidemiol 2015; 36:1117-8. [PMID: 26006190 DOI: 10.1017/ice.2015.134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kasapoglu US, Arınç S, Gungor S, Irmak I, Guney P, Aksoy F, Bandak D, Hazar A. Prognostic factors affecting survival in non-small cell lung carcinoma patients with malignant pleural effusions. CLINICAL RESPIRATORY JOURNAL 2015; 10:791-799. [PMID: 25764010 DOI: 10.1111/crj.12292] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 12/10/2014] [Accepted: 02/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Lung cancer is the most common cause of malignant pleural effusions (MPEs). For patients with lung cancer and MPE, median survival is only 3-4 months. The aim of this study was to evaluate lung cancer patients with MPE by clinical and laboratory findings on admission, and determine 2-year survival rate and prognostic factors. METHODS Between 2008 and 2011, we examined 199 cases of non-small cell lung carcinoma with MPE. Demographic factors of patients, tumor characteristics, treatment delivered and laboratory parameters affecting prognosis were evaluated. Survival rates were estimated by Kaplan-Meier method. Significance of each prognostic factors selected by univariate analysis were confirmed using Cox regression model. RESULTS The study included 139 (69.8%) male and 60 (30.2%) female patients with a median age of 64 (30-85) years. Median overall survival was 4.4 months. Adenocarcinoma was the leading cause of MPE with 80.4%. A univariate analysis showed that factors affecting mortality included gender (P < 0.001), MPE with distant metastasis (P = 0.025), lower serum albumin (P < 0.0001), lower pleural protein (P < 0.0001), increased serum lactate dehydrogenase (P = 0.003), increased serum C-reactive protein (CRP) (P < 0.0001), increased white blood cells (P < 0.0001), histopathological type (P = 0.004) and treatment decision (P < 0.0001). A multivariate analysis revealed that patients who had high level of serum CRP (P = 0.017), lower serum albumin (P = 0.009) and lower pleural protein (P = 0.003), MPE with distant metastasis (P = 0.003) and those who were chemotherapy naive (P < 0.0001) had shorter survival. CONCLUSION High level of serum CRP, lower serum albumin and lower pleural protein, MPE with distant metastasis were most important prognostic factors for non-small cell lung carcinoma in patients with MPEs.
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Affiliation(s)
- Umut Sabri Kasapoglu
- Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Sibel Arınç
- Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sinem Gungor
- Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ilim Irmak
- Department of Chest Diseases, Dr. Sureyya Adanali Goksun State Hospital, Kahramanmaras, Turkey
| | - Pinar Guney
- Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ferda Aksoy
- Department of Pathology, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Dilek Bandak
- Department of Clinical Biochemistry, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Armagan Hazar
- Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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He X, Zhou T, Yang Y, Hong S, Zhan J, Hu Z, Fang W, Qin T, Ma Y, Zhao Y, Cheng Z, Huang Y, Zhao H, Yang G, Zhang L. Advanced Lung Cancer Inflammation Index, a New Prognostic Score, Predicts Outcome in Patients With Small-Cell Lung Cancer. Clin Lung Cancer 2015; 16:e165-71. [PMID: 25922292 DOI: 10.1016/j.cllc.2015.03.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/16/2015] [Accepted: 03/19/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED This report is the first to use the value of the Advanced Lung Cancer Inflammation Index (ALI) to predict the overall survival in patients with small-cell lung cancer. We enrolled 365 patients who were eligible for analysis and found that lower ALI was significantly associated with worse overall survival in small-cell lung cancer patients. The results showed that evaluation using ALI could authenticate the patients with poor prognosis and be a useful prognostic marker in clinical practice. BACKGROUND A recent study indicated that the Advanced Lung Cancer Inflammation Index (ALI) could predict overall survival (OS) in patients with non-small-cell lung cancer. However, the prognostic value in small-cell lung cancer (SCLC) has not been studied. Therefore, the aim of this study was to explore the relationship between ALI and the prognosis of SCLC. PATIENTS AND METHODS We screened 460 patients who were diagnosed with SCLC from June 2006 to December 2011 in Sun Yat-Sen University Cancer Center. Data acquisition was through patients' medical information, and blood results recorded at the time of diagnosis. ALI was calculated as the formula: body mass index × serum albumin/neutrophil-lymphocyte ratio. RESULTS In total, 365 patients were enrolled in this study. Patients were allocated to 2 groups: ALI < 19.5 (n = 60) and ALI ≥ 19.5 (n = 305). For patients with ALI < 19.5 and ≥ 19.5, the median OS was 10.97 and 20.14 months, respectively (P < .001). On multivariate analysis, clinical stage (P < .001), performance status (P = .001), lactate dehydrogenase (P < .001), and ALI (P = .005) were all independent prognostic factors for OS. CONCLUSION The results of this study demonstrated that lower ALI was significantly associated with worse OS in SCLC patients. The evaluation of ALI could authenticate the patients with poor prognosis and be a useful prognostic marker in clinical practice.
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Affiliation(s)
- Xiaobo He
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ting Zhou
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yunpeng Yang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shaodong Hong
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jianhua Zhan
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhihuang Hu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wenfeng Fang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Tao Qin
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yuxiang Ma
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yuanyuan Zhao
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhibin Cheng
- Department of Oncological Radiotherapy, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Yan Huang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hongyun Zhao
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guangwei Yang
- Department of Oncological Radiotherapy, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
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Do preoperative serum C-reactive protein levels predict the definitive pathological stage in patients with clinically localized prostate cancer? Int Urol Nephrol 2015; 47:765-70. [DOI: 10.1007/s11255-015-0952-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/09/2015] [Indexed: 12/14/2022]
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Pathak S, Nunes QM, Daniels IR, Smart NJ. Is C-reactive protein useful in prognostication for colorectal cancer? A systematic review. Colorectal Dis 2014; 16:769-76. [PMID: 25039573 DOI: 10.1111/codi.12700] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/03/2014] [Indexed: 12/16/2022]
Abstract
AIM With the advent of several different therapeutic strategies to manage the different stages of colorectal cancer, it would be beneficial to allow substratification of patients into groups who are most likely to benefit from costly interventions. The purpose of this review is to analyse the evidence from several retrospective studies examining the prognostic significance of C-reactive protein (CRP). METHOD A literature search was performed using PubMed, Embase, Cochrane Library, CINAHL and Google Scholar databases to identify studies that analysed CRP and its prognostic significance in all stages of operable colorectal cancer. The primary end-points of interest were overall survival and disease-free survival. RESULTS In all, 205 studies were identified by the search. Twelve involving 1705 patients fulfilled the inclusion criteria and were included. Three of the included studies including 305 patients considered Stage IV colorectal cancer and the impact of CRP on survival. Overall survival and disease-free survival were shorter in the presence of an elevated preoperative CRP in local and advanced colorectal cancer. CONCLUSION CRP may be useful for prognosis in patients with primary and metastatic colorectal cancer, but currently there is insufficient evidence to justify its routine use. Further well-designed prospective studies are needed to validate its role in substratification of patients for consideration of (neo)adjuvant therapies.
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Affiliation(s)
- S Pathak
- Department of HpB and Transplant Surgery, St James's University Hospital, Leeds, UK
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Ryan BM, Pine SR, Chaturvedi AK, Caporaso N, Harris CC. A combined prognostic serum interleukin-8 and interleukin-6 classifier for stage 1 lung cancer in the prostate, lung, colorectal, and ovarian cancer screening trial. J Thorac Oncol 2014; 9:1494-503. [PMID: 25170636 PMCID: PMC4272608 DOI: 10.1097/jto.0000000000000278] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The advent of low-dose helical computed tomography for lung cancer screening will likely lead to an increase in the detection of stage I lung cancer. Presently, these patients are primarily treated with surgery alone and approximately 30% will develop recurrence and die. Biomarkers that can identify patients for whom adjuvant chemotherapy would be a benefit could significantly reduce both patient morbidity and mortality. Herein, we sought to build a prognostic inflammatory-based classifier for stage I lung cancer. METHODS We performed a retrospective analysis of 548 European American lung cancer cases prospectively enrolled in the Prostate, Lung, Colorectal and Ovarian study. C-reactive protein, interleukin (IL)-6, IL-8, tumor necrosis factor-α, and IL-1β were measured using an ultrasensitive electrochemiluminescence immunoassay in serum samples collected at the time of study entry. RESULTS IL-6 and IL-8 were each associated with significantly shorter survival (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.08-1.64; p = 0.007; and HR, 1.3; 95% CI, 1.09-1.67; p = 0.005, respectively). Moreover, a combined classifier of IL-6 and IL-8 were significantly associated with poor outcome in stage I lung cancer patients (HR, 3.39; 95% CI, 1.54-7.48, p = 0.002) and in stage 1 patients with more than or equal to 30 pack-years of smoking (HR, 3.15; 95% CI, 1.54-6.46, p = 0.002). CONCLUSIONS These results further support the association between inflammatory markers and lung cancer outcome and suggest that a combined serum IL-6/IL-8 classifier could be a useful tool for guiding therapeutic decisions in patients with stage I lung cancer.
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Affiliation(s)
- Bríd M. Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20892
| | - Sharon R. Pine
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ 08903
| | - Anil K. Chaturvedi
- Infections and Immunoepidemiology Branch Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20892
| | - Neil Caporaso
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20892
| | - Curtis C. Harris
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20892
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Zhou T, Hong S, Hu Z, Hou X, Huang Y, Zhao H, Liang W, Zhao Y, Fang W, Wu X, Qin T, Zhang L. A systemic inflammation-based prognostic scores (mGPS) predicts overall survival of patients with small-cell lung cancer. Tumour Biol 2014; 36:337-43. [PMID: 25256672 DOI: 10.1007/s13277-014-2623-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 09/10/2014] [Indexed: 12/18/2022] Open
Abstract
Recent studies have shown the combination of C-reactive protein (CRP) and albumin (The modified Glasgow Prognostic Score, mGPS) had prognostic value in some solid tumors. However, no studies have examined its prognostic role in small-cell lung cancer (SCLC) patients. In this retrospective study, 460 consecutive SCLC patients were screened. Eligible patient was assigned a mGPS of 0, 1, or 2 based on pre-treatment plasma CRP and albumin (0: CRP ≤ 10 mg/L; 1: CRP >10 mg/L and albumin ≥ 35 g/L; 2: CRP > 10 mg/L and albumin < 35 g/L). Univariate and multivariate analyses were performed to assess the prognostic value of relevant factors for SCLC. A total of 359 patients were analyzed. The mGPS of 0, 1, and 2 was assigned to 66.3, 30.6, and 3.1 % of total patients. For patients with mGPS of 0, 1, and 2, median overall survival (OS) was 30.4, 28.2, and 14.3 months, respectively (P < 0.001). Performance status (P < 0.001), disease stage (P < 0.001) and pre-treatment LDH (P < 0.001) also significantly predicted OS. Multivariate analyses showed mGPS was an independent prognostic factor (P < 0.001). This study demonstrated that higher mGPS independently predicts worse OS for SCLC patients. The assessment of mGPS could assist the identification of patients with poor prognosis and be a hierarchical factor in the future SCLC clinical trials.
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Affiliation(s)
- Ting Zhou
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, 651# Dongfeng East Road, Guangzhou, China, 510060
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Aref H, Refaat S. CRP evaluation in non-small cell lung cancer. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2014.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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The prognostic impact of the neutrophil-to-lymphocyte ratio in patients with small-cell lung cancer. Br J Cancer 2014; 111:452-60. [PMID: 24921916 PMCID: PMC4119986 DOI: 10.1038/bjc.2014.317] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/24/2014] [Accepted: 05/12/2014] [Indexed: 12/11/2022] Open
Abstract
Background: The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are prognostic factors for various types of cancer. In this study, we assessed the association of NLR and PLR with the prognosis of small-cell lung cancer (SCLC) in patients who received the standard treatment. Methods: We retrospectively reviewed patients who were diagnosed with SCLC and treated with platinum-based chemotherapy between July 2006 and October 2013 in Gyeongsang National University Hospital Regional Cancer Center and Changwon Samsung Hospital. Results: In total, 187 patients were evaluated. Compared with low NLR (<4), high NLR (⩾4) at diagnosis was associated with poor performance status, advanced stage, and lower response rate. Median overall survival (OS) and progression-free survival (PFS) were worse in the high-NLR group (high vs low, 11.17 vs 9.20 months, P=0.019 and 6.90 vs 5.49 months, P=0.005, respectively). In contrast, PLR at diagnosis was not associated with OS or PFS (P=0.467 and P=0.205, respectively). In multivariate analysis, stage, lactate dehydrogenase, and NLR at diagnosis were independent prognostic factors for OS and PFS. Conclusions: NLR is easily measurable and reflects the SCLC prognosis. A future prospective study is warranted to confirm our results.
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Park MR, Park YH, Choi JW, Park DI, Chung CU, Moon JY, Park HS, Jung SS, Kim JO, Kim SY, Lee JE. Progression-free survival: an important prognostic marker for long-term survival of small cell lung cancer. Tuberc Respir Dis (Seoul) 2014; 76:218-25. [PMID: 24920948 PMCID: PMC4050069 DOI: 10.4046/trd.2014.76.5.218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 02/24/2014] [Accepted: 03/14/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Small cell lung cancer (SCLC) is an extremely aggressive tumor with a poor clinical course. Although many efforts have been made to improve patients' survival rates, patients who survive longer than 2 years after chemotherapy are still very rare. We examined the baseline characteristics of patients with long-term survival rates in order to identify the prognostic factors for overall survivals. METHODS A total of 242 patients with cytologically or histologically diagnosed SCLC were enrolled into this study. The patients were categorized into long- and short-term survival groups by using a survival cut-off of 2 years after diagnosis. Cox's analyses were performed to identify the independent factors. RESULTS The mean patient age was 65.66 years, and 85.5% were males; among the patients, 61 of them (25.2%) survived longer than 2 years. In the multivariate analyses, CRP (hazard ratio [HR], 2.75; 95% confidence interval [CI], 1.25-6.06; p=0.012), TNM staging (HR, 3.29; 95% CI, 1.59-6.80; p=0.001), and progression-free survival (PFS) (HR, 11.14; 95% CI, 2.98-41.73; p<0.001) were independent prognostic markers for poor survival rates. CONCLUSION In addition to other well-known prognostic factors, this study discovered relationships between the long-term survival rates and serum CRP levels, TNM staging, and PFS. In situations with unfavorable conditions, the PFS would be particularly helpful for managing SCLC patients.
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Affiliation(s)
- Myoung-Rin Park
- Department of Public Health Administration, The Province of Chungcheongnam-do, Hongseong, Korea
| | - Yeon-Hee Park
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae-Woo Choi
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Dong-Il Park
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Chae-Uk Chung
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae-Young Moon
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hee-Sun Park
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sung-Soo Jung
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ju-Ock Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sun-Young Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeong-Eun Lee
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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C-reactive protein level is a prognostic indicator for survival and improves the predictive ability of the R-IPI score in diffuse large B-cell lymphoma patients. Br J Cancer 2014; 111:55-60. [PMID: 24874478 PMCID: PMC4090740 DOI: 10.1038/bjc.2014.277] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/17/2014] [Accepted: 04/28/2014] [Indexed: 12/22/2022] Open
Abstract
Background: High levels of C-reactive protein (CRP), an acute phase protein, proofed being associated with decreased clinical outcome in small-scale studies in diffuse large B-cell lymphoma (DLBCL). The aim of this study was to evaluate the prognostic impact of pretreatment CRP levels on overall survival (OS) and disease-free survival (DFS) in a large bicentre study of DLBCL patients. Methods: Data from 477 DLBCL patients, diagnosed and treated between 2004 and 2013 at two Austrian centres, were evaluated retrospectively. The prognostic influence of CRP and other factors, including age, tumour stage, and revised International Prognostic Index (R-IPI) on 5-year OS and 5-year DFS, were studied by Kaplan–Meier curves as well as univariate and multivariate Cox regression models. Influence of CRP on the predictive accuracy of the R-IPI score was determined by the Harrell concordance index. Results: Kaplan–Meier curves revealed elevated CRP as a factor for decreased 5-year OS and DFS in DLBCL patients (P<0.001, log-rank test). An independent significant association between high CRP levels and poor clinical outcome in multivariate analysis for 5-year OS (HR=1.51, CI 95%=1.04–2.20, P=0.031) and for DFS (HR=1.91, CI 95%=1.28–2.85, P=0.002) was found. The estimated concordance index was 0.75 using the original R-IPI score and 0.79 when CRP was added. Conclusions: In the present study, we demonstrated high CRP levels at diagnosis of DLBCL as an independent poor prognostic factor for clinical outcome. Adding CRP to the well-established prognostic models such as the R-IPI score might improve their predictive ability.
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Agassandian M, Shurin GV, Ma Y, Shurin MR. C-reactive protein and lung diseases. Int J Biochem Cell Biol 2014; 53:77-88. [PMID: 24853773 DOI: 10.1016/j.biocel.2014.05.016] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 12/13/2022]
Abstract
C-reactive protein (CRP), a member of the pentraxin family of plasma proteins, is one of the most distinctive acute phase reactants. In response to inflammation, cell damage or tissue injury, plasma level of CRP rapidly and dramatically increases up to 1000-fold, a phenomenon that has been used for years to monitor infections and many destructive/inflammatory conditions. The magnitude of CRP increase usually correlates with the severity of injury or inflammation and reflects an important physiological role of this interesting but still under-investigated protein. It is now generally accepted that CRP is involved in host defense and inflammation. However, the exact function of this protein in health and disease remains unclear. Many studies have demonstrated that in different pathophysiological conditions CRP might be involved in the regulation of lung function and may participate in the pathogenesis of various pulmonary disorders. The fluctuation of CRP concentrations in both alveolar fluid and serum associated with different pulmonary diseases suggests its important role in lung biology. Discussion of the still controversial functions of CRP in lung physiology and diseases is the main focus of this review.
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Affiliation(s)
- Marianna Agassandian
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Galina V Shurin
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yang Ma
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael R Shurin
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Yi JH, Wang D, Li ZY, Hu J, Niu XF, Liu XL. C-reactive protein as a prognostic factor for human osteosarcoma: a meta-analysis and literature review. PLoS One 2014; 9:e94632. [PMID: 24800842 PMCID: PMC4011684 DOI: 10.1371/journal.pone.0094632] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 03/19/2014] [Indexed: 12/12/2022] Open
Abstract
Background Osteosarcoma is the most common primary bone cancer in growing adolescents and young adults. The prognostic role of C-reactive protein (CRP) in patients with osteosarcoma is not fully investigated. The purpose of this study is to perform a meta-analysis and literature review on the role of CRP in osteosarcoma and to assess the potential role of serum CRP as a prognostic factor for patients with osteosarcoma. Methods A detailed literature search was made in Medline for related research publications written in English. Methodological quality of the studies was also evaluated. The data were extracted and assessed by two reviewers independently. Analysis of pooled data were performed, risk ratio (RR) and corresponding confidence intervals (CIs) were calculated and summarized respectively. Results Final analysis of 397 patients from 2 eligible studies was performed. Combined RR of CRP expression suggested that the raised serum CRP level had an adverse prognostic effect on overall survival of patients with osteosarcoma (n = 397 in 2 studies; RR = 0.35; 95% CI: 0.18–0.68; p = 0.002). In the uni- and multivariate survival analysis, response rate and CRP levels were the only independent prognostic variables. Conclusions The results of this meta-analysis suggest that CRP expression confers a worse prognosis in patients with osteosarcoma. Large prospective studies are necessary to provide solid data to confirm the prognostic significance of CRP.
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Affiliation(s)
- Jian-Hua Yi
- The Upper Limb Orthopedic Department of Huang Pu Award, The First Affiliated Hospital of Sun Yat-Sen University Guangzhou, China
| | - Dong Wang
- The Upper Limb Orthopedic Department of Huang Pu Award, The First Affiliated Hospital of Sun Yat-Sen University Guangzhou, China
| | - Zhi-Yong Li
- The Upper Limb Orthopedic Department of Huang Pu Award, The First Affiliated Hospital of Sun Yat-Sen University Guangzhou, China
- * E-mail:
| | - Jun Hu
- The Upper Limb Orthopedic Department of Huang Pu Award, The First Affiliated Hospital of Sun Yat-Sen University Guangzhou, China
| | - Xiao-Feng Niu
- The Upper Limb Orthopedic Department of Huang Pu Award, The First Affiliated Hospital of Sun Yat-Sen University Guangzhou, China
| | - Xiao-Lin Liu
- The Upper Limb Orthopedic Department of Huang Pu Award, The First Affiliated Hospital of Sun Yat-Sen University Guangzhou, China
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Small steps of improvement in small-cell lung cancer (SCLC) within two decades: A comprehensive analysis of 484 patients. Lung Cancer 2014; 84:168-74. [DOI: 10.1016/j.lungcan.2014.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/18/2014] [Accepted: 02/10/2014] [Indexed: 11/21/2022]
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Al Ghazal A, Steffens S, Steinestel J, Lehmann R, Schnoeller TJ, Schulte-Hostede A, Wegener G, Jentzmik F, Schrader M, Kuczyk MA, Schrader AJ. Elevated C-reactive protein values predict nodal metastasis in patients with penile cancer. BMC Urol 2013; 13:53. [PMID: 24148787 PMCID: PMC4016472 DOI: 10.1186/1471-2490-13-53] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 10/15/2013] [Indexed: 11/26/2022] Open
Abstract
Background The nodal status is a strong predictor for cancer specific death in patients with penile carcinoma, and the C-reactive protein (CRP) level at diagnosis has recently been shown to be associated with poor clinical outcome in various solid malignancies. Therefore, this retrospective study was performed to evaluate the association between preoperative CRP levels and the incidence of nodal metastasis in patients with squamous cell carcinoma (SCC) of the penis. Methods The analysis included 51 penile cancer patients who underwent either radical or partial penectomy for pT1-4 penile cancer between 1990 and 2010. The nodal status was correlated with patient and tumor specific characteristics. Results Sixteen (31%) patients had lymph node metastasis at the time of penile cancer surgery. Nodal status was associated with tumor stage but did not correlate significantly with tumor grade. In contrast, high presurgical CRP levels were significantly associated with the diagnosis of nodal involvement (p = 0.04). The optimal CRP cut-off value to predict lymph node metastasis was set at 20 mg/l based on ROC analysis. Conclusions Since a high preoperative serum CRP level was closely correlated with nodal disease, it could be used as an additional marker to help identify patients with penile cancer who may benefit from inguinal lymph node dissection.
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Affiliation(s)
| | - Sandra Steffens
- Department of Urology, Hannover Medical School, Carl-Neuberg-Str, 1, D-30625 Hannover, Germany.
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Song ZB, Lin BC, Li B, He CX, Zhang BB, Shao L, Zhang YP. Preoperative elevation of serum C-reactive protein as an indicator of poor prognosis for early-stage esophageal squamous cell carcinoma. Kaohsiung J Med Sci 2013; 29:662-6. [PMID: 24296054 DOI: 10.1016/j.kjms.2013.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 10/22/2012] [Indexed: 11/30/2022] Open
Abstract
Preoperative elevation of serum C-reactive protein (CRP) is reportedly associated with poor prognosis in several types of cancer. This study investigated the role of serum CRP as a prognostic factor in early-stage esophageal squamous cell carcinoma (ESCC). The preoperative serum CRP levels were measured in 156 newly diagnosed pT1-2N0M0 patients using an enzyme-linked immunosorbent assay. Correlations between serum CRP levels and other clinical parameters were analyzed. Multivariate analyses were performed to find prognostic markers using Cox's proportional hazards model. CRP concentrations were within the normal range in 117 (75%) individuals, but were elevated in 39 (25%) patients. Serum CRP levels were significantly correlated with the tumor length (p = 0.032), depth (T classification, p = 0.0157), or histologic grade (p = 0.034). The overall 5-year survival rates were 76.3% and 50.2% in the low- and high-CRP groups, respectively (p = 0.005). By multivariate analyses, the elevated serum CRP level was found to be an independent prognostic factor for poor survival (hazard ratio = 2.131; p = 0.007), regardless of tumor classification or other prognostic factors. In conclusion, preoperative, high serum CRP is an independent determinant of poor prognosis in early-stage ESCC.
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Affiliation(s)
- Zheng-Bo Song
- Department of Chemotherapy, Zhejiang Cancer Hospital, Hangzhou, China; Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Hangzhou, Zhejiang Province, China
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Li YN, Zhang L, Li XL, Cui DJ, Zheng HD, Yang SY, Yang WL. Glycoprotein nonmetastatic B as a prognostic indicator in small cell lung cancer. APMIS 2013; 122:140-6. [PMID: 23656629 DOI: 10.1111/apm.12107] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 03/17/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Ying-Na Li
- Department of Geriatrics; The Second Affiliated Hospital; Medical School of Xi'an Jiaotong University Xi'an; Xi'an China
| | - Lin Zhang
- Department of Geriatrics; The Second Affiliated Hospital; Medical School of Xi'an Jiaotong University Xi'an; Xi'an China
| | - Xiu-Li Li
- Department of Geriatrics; The Second Affiliated Hospital; Medical School of Xi'an Jiaotong University Xi'an; Xi'an China
| | - Da-Jiang Cui
- Department of Geriatrics; The Second Affiliated Hospital; Medical School of Xi'an Jiaotong University Xi'an; Xi'an China
| | - Hua-Dong Zheng
- Department of Geriatrics; The Second Affiliated Hospital; Medical School of Xi'an Jiaotong University Xi'an; Xi'an China
| | - Shuan-Ying Yang
- Department of Respiratory Medicine; The Second Affiliated Hospital; Medical School of Xi'an Jiaotong University; Xi'an China
| | - Wei-Lin Yang
- Department of Geriatrics; The Second Affiliated Hospital; Medical School of Xi'an Jiaotong University Xi'an; Xi'an China
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Steffens S, Al Ghazal A, Steinestel J, Lehmann R, Wegener G, Schnoeller TJ, Cronauer MV, Jentzmik F, Schrader M, Kuczyk MA, Schrader AJ. High CRP values predict poor survival in patients with penile cancer. BMC Cancer 2013; 13:223. [PMID: 23642165 PMCID: PMC3649950 DOI: 10.1186/1471-2407-13-223] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 04/25/2013] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND High levels of circulating C-reactive protein (CRP) have recently been linked to poor clinical outcome in various malignancies. The aim of this study was to evaluate the prognostic significance of the preoperative serum CRP level in patients with squamous cell carcinoma (SCC) of the penis. METHODS This retrospective analysis included 79 penile cancer patients with information about their serum CRP value prior to surgery who underwent either radical or partial penectomy at two German high-volume centers (Ulm University Medical Center and Hannover Medical School) between 1990 and 2010. They had a median (mean) follow-up of 23 (32) months. RESULTS A significantly elevated CRP level (>15 vs. ≤ 15 mg/l) was found more often in patients with an advanced tumor stage (≥pT2) (38.9 vs. 11.6%, p=0.007) and in those with nodal disease at diagnosis (50.0 vs. 14.6%, p=0.007). However, high CRP levels were not associated with tumor differentiation (p=0.53). The Kaplan-Meier 5-year cancer-specific survival (CSS) rate was 38.9% for patients with preoperative CRP levels above 15 mg/l and 84.3% for those with lower levels (p=0.001). Applying multivariate analysis and focusing on the subgroup of patients without metastasis at the time of penile surgery, both advanced local tumor stage (≥pT2; HR 8.8, p=0.041) and an elevated CRP value (>15 mg/l; HR 3.3, p=0.043) were identified as independent predictors of poor clinical outcome in patients with penile cancer. CONCLUSIONS A high preoperative serum CRP level was associated with poor survival in patients with penile cancer. If larger patient populations confirm its prognostic value, its routine use could enable better risk stratification and risk-adjusted follow-up of patients with SCC of the penis.
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Affiliation(s)
- Sandra Steffens
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Andreas Al Ghazal
- Department of Urology, Ulm University Medical Center, Pritzwitzstrasse 43, Ulm, D-89075, Germany
| | - Julie Steinestel
- Department of Urology, Ulm University Medical Center, Pritzwitzstrasse 43, Ulm, D-89075, Germany
| | - Rieke Lehmann
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Gerd Wegener
- Cancer Center, Hannover Medical School, Hannover, Germany
| | - Thomas J Schnoeller
- Department of Urology, Ulm University Medical Center, Pritzwitzstrasse 43, Ulm, D-89075, Germany
| | - Marcus V Cronauer
- Department of Urology, Ulm University Medical Center, Pritzwitzstrasse 43, Ulm, D-89075, Germany
| | - Florian Jentzmik
- Department of Urology, Ulm University Medical Center, Pritzwitzstrasse 43, Ulm, D-89075, Germany
| | - Mark Schrader
- Department of Urology, Ulm University Medical Center, Pritzwitzstrasse 43, Ulm, D-89075, Germany
| | - Markus A Kuczyk
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Andres J Schrader
- Department of Urology, Ulm University Medical Center, Pritzwitzstrasse 43, Ulm, D-89075, Germany
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43
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Xu M, Zhu M, Du Y, Yan B, Wang Q, Wang C, Zhao J. Serum C-reactive protein and risk of lung cancer: a case-control study. Med Oncol 2012; 30:319. [PMID: 23254959 DOI: 10.1007/s12032-012-0319-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 07/14/2012] [Indexed: 12/21/2022]
Abstract
Recent advances in lung cancer biology presuppose their inflammatory origin. Thus, CRP is regarded to play a key role in the development of lung cancer. Nevertheless, this interesting hypothesis and the role of inflammation in tumor biology remain complex and incompletely sure. Meanwhile, the association between CRP and risk of lung cancer was not stable in many published results. This study was conducted to evaluate the association between serum CRP and SNPs in the aspect of lung cancer risks, in order to assess its possible diagnostic and prognostic importance. We conducted a case-control study of 96 patients newly diagnosed of lung cancer and 124 controls in this research. Controls were individuals matched to lung cancer cases on age, gender and tobacco use. In order to increase the statistical power, never smokers were matched to patients by using a 3:1 ratio, whereas former and current smokers were matched equal to the patients. CRP concentrations were measured using a chemiluminescent immunoassay, and SNPs were assessed at five loci within the CRP gene (rs1417938, rs1800947, rs1205, rs2808630 and rs3093077) as part of a Golden Gate assay. Logistic regression was used to calculate OR and 95 % CI for lung cancer. CRP concentrations tended to be in positive association with lung cancer risk in our research (Q4 vs Q1: OR = 2.11, 95 % CI, 1.66-2.91, p trend < 0.01). Although CRP SNPs were related to CRP levels, they were not associated with lung cancer risk. In combined analyses, we observed a significant interaction (p (interaction) = 0.02) that positive associations were suggestive in younger (Q4 vs Q1: OR = 1.65, 95 % CI, 1.02-2.67, p trend = 0.18) and older individuals (Q4 vs Q1: OR = 2.66, 95 % CI, 1.45-3.98 p trend = 0.42). The risks of lung cancer were higher with elevated CRP levels among former smokers and current smokers. High levels of CRP were associated with increasing lung cancer risk, suggesting that CRP could be used as surrogate biomarker of angiogenesis and prognosis in lung cancer.
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Affiliation(s)
- Ming Xu
- Department of Thoracic and Cardiovascular Surgery, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China
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44
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Carpenter LL, Gawuga CE, Tyrka AR, Price LH. C-reactive protein, early life stress, and wellbeing in healthy adults. Acta Psychiatr Scand 2012; 126:402-10. [PMID: 22681496 PMCID: PMC3580169 DOI: 10.1111/j.1600-0447.2012.01892.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine whether C-reactive protein (CRP) can serve as a marker for alterations in immune function prior to the manifestation of significant psychiatric and medical disorders. METHOD Ninety-two healthy adults were recruited from the community and determined to be free of psychiatric or medical disorders. The concentration of plasma CRP from a single resting sample was examined in relation to current mental and physical health as well as to self-reported history of early life adversity. RESULTS C-reactive protein showed a significant positive correlation with body mass index (BMI; r = 0.477, P < 0.001). Non-specific pain, fatigue, and lower overall quality of physical health were all associated with higher CRP concentrations (all P < 0.05 or P < 0.01), after controlling for effect of BMI and other relevant covariates. Subthreshold depression symptoms and other indices of mental/emotional wellbeing were not associated with CRP, nor was CRP significantly linked to any measures of early life adversity. CONCLUSION Lower-quality physical health and wellbeing, but not the presence of mood/anxiety symptoms or early life stress (ELS), were significantly related to plasma CRP. Elevated CRP does not appear to be a fundamental consequence of ELS among healthy adults.
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Affiliation(s)
- L. L. Carpenter
- Mood Disorders Research Program and Laboratory for Clinical Neuroscience, Butler Hospital, Providence, RI,Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, RI
| | - C. E. Gawuga
- Department of Molecular Pharmacology, Physiology and Biotechnology, Brown University, Providence, RI, USA
| | - A. R. Tyrka
- Mood Disorders Research Program and Laboratory for Clinical Neuroscience, Butler Hospital, Providence, RI,Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, RI
| | - L. H. Price
- Mood Disorders Research Program and Laboratory for Clinical Neuroscience, Butler Hospital, Providence, RI,Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, RI
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