Elsevier

Gynecologic Oncology

Volume 107, Issue 1, October 2007, Pages 114-117
Gynecologic Oncology

C-reactive protein is a prognostic parameter in patients with cervical cancer

https://doi.org/10.1016/j.ygyno.2007.06.001Get rights and content

Abstract

Objective.

To evaluate whether C-reactive protein (CRP) serum levels can be used as a prognostic parameter in patients with cervical cancer.

Methods.

In the present study, CRP serum levels were measured in 215 patients with cervical cancer. CRP serum levels were measured prior to therapy for cervical cancer and were correlated to clinical data.

Results.

The median CRP serum level in patients with cervical cancer was 0.5 mg/dl (interquartile range 0.5–0.9 mg/dl). CRP serum levels were significantly associated with advanced tumor stage (p < 0.001), lymph node involvement (p = 0.01) and patients' age (p = 0.01), but not with histological grade (p = 0.1) and histological type (p = 0.9). In a univariate and multivariate analysis CRP serum levels, tumor stage, and lymph node involvement, but not histological grade, histological type and patients' age were associated with overall and disease-free survival.

Conclusion.

CRP serum levels can be used as additional prognostic parameter in patients with cervical cancer.

Introduction

C-reactive protein (CRP) is the prototypical acute phase serum protein, rising rapidly in response to inflammation. CRP binds to phosphocholine and related molecules on microorganisms and plays an important role in host defense [1].

Clinically, CRP has been used to detect acute infections and to assess the response to treatment [2]. It has also been used to eva>luate the inflammatory response in chronic diseases, such as vasculitis and rheumatoid arthritis [3]. In addition, CRP serum levels slightly above normal have been put forth as an indicator of mild inflammation associated with atherosclerotic vascular disease [1], [4].

Today, the causal relationship between inflammation, innate immunity and cancer is widely accepted. Many cancers arise from sites of infection, chronic irritation and inflammation [5], [6]. Tumor microenvironment, which is largely mediated by inflammatory cells, is a participant in the neoplastic process, promoting proliferation, survival and migration. In addition, tumor cells have co-opted some of the signaling molecules of the innate immune system, such as selectins, chemokines and their receptors for invasion, migration and metastasis [7].

Circulating CRP has been investigated in various human malignancies, both as risk factor [8], [9], [10], [11] and as prognostic parameter. Elevated CRP serum levels have been found to be associated with a poor prognosis in patients with myeloma [12], esophageal [13], [14], hepatocellular [15], colorectal [16], [17], [18], renal cell [19], [20] and lung cancer [21], [22].

The aim of the present study was to investigate the value of CRP serum levels as prognostic parameter in patients with cervical cancer.

Section snippets

Patients

Two hundred fifteen patients with invasive cervical cancer, treated between January 1995 and December 2006, were enrolled in the present study. Clinical data were extracted from files at the Department of Obstetrics and Gynecology, Medical University of Vienna.

Clinical management

Microinvasive cervical cancer (FIGO IA1) was treated either with conization or by simple hysterectomy. Early stage disease (FIGO IA2, IB1, and IIA) was managed by radical hysterectomy plus pelvic/paraaortic lymphadenectomy with or without

Results

Patients' characteristics are given in Table 1. Median CRP serum levels in patients with cervical cancer were 0.5 mg/dl (0.5–0.9 mg/dl) prior to therapy. Associations between median CRP serum levels and clinico-pathological parameters are given in Table 2. CRP serum levels were significantly associated with advanced tumor stage, lymph node involvement, and patients' age, but not with histological grade and type.

CRP serum levels, tumor stage, lymph node involvement, histological grade and type,

Discussion

To the best of our knowledge, we present the first study to date with respect to the prognostic value of CRP serum levels, the most prominent biomarker of inflammation, in patients with cervical cancer.

It is well established that cervical cancer is strongly associated with human papillomavirus (HPV) infection. Transformation of cells and subsequent cervical carcinogenesis has been shown to require persisting expression of two viral non-structural proteins (E6 and E7). Together they inhibit

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