Preoperative serum C-reactive protein and gastric cancer; Clinical-pathological correlation and prognostic significance

Background: C-reactive protein (CRP) is a widely-used systemic biomarker for inflammation. Serum CRP is elevated in many malignancies, and is also a prognostic indicator of malignant potential. However, the prognostic significance for survival from gastric cancer has not yet been clarified. We studied the clinical-pathologic association and prognostic significance of preoperative serum CRP in gastric cancer patients. Methods: A total of 170 gastric cancer patients were included in this study. The mean age of the patients was 65.1 years (range, 29-89), and 112 were men. All gastric cancer patients had undergone gastric resection. The serum CRP levels of patients before the operation along with those from 405 healthy controls were measured by a high sensitivity CRP test. Results: The 95th percentile value (= 3.0 mg/L) of the serum CRP data in 405 healthy controls was set as the upper cut-off value of the normal range. Abnormally high levels of serum CRP were observed in 65 (38.2%) of our 170 patients in contrast to only 20 (4.9%) of the 405 healthy controls (p < 0.001). Elevated CRP was associated with older age (p = 0.009), grossly infiltrative type (p = 0.001), larger tumors (p < 0.001), serosal invasion (p = 0.001), lymph node metastasis (p < 0.001), distant metastasis (p = 0.017), and lymphatic invasion (p = 0.002). Overall, a higher CRP level was strongly parallel to a pathologically more advanced stage (p = 0.001). The 5-yr survival rate of patients with an elevated (> 3.0 mg/L) CRP was significantly worse than those without (≤ 3.0 mg/L) (27.1% versus 54.1%, log rank p = 0.0010). Conclusion: The preoperative serum CRP level was abnormally elevated in 38.2% of gastric cancer patients. Elevated CRP was associated with progressive disease or an advanced stage, and a worse survival. Although serum CRP is not a specific biomarker for gastric cancer, it might be a potential prognostic biomarker and a promising therapeutic target for gastric cancer patients.