C-reactive protein is a 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.
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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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