Evaluation of Preoperative Elevation of Serum C-Reactive Protein as an Indicator for Prognosis in Colorectal Cancer

Background: The C-reactive protein (CRP) is a product synthesized in hepatocytes and has been reported to be up-regulated by such proinflammatory cytokines as interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor (TNF). The significance of a preoperative serum elevation in CRP as a predictive indicator for the malignant potential and prognosis in colorectal cancer has not been elucidated.

Method: Forty consecutive patients with colorectal cancer, whose local lesions were resected in our department, plus forty volunteer healthy persons, were selected. Any patient with inflammatory diseases such as infection or collagen disease was excluded from the current study. Then preoperative serum CRP level were measured, and also from the control group. The relationships between the serum elevation of CRP and both the clinicopathologic factors and prognosis of the patients was investigated.

Results: The rate of patients with elevated serum CRP level was significantly higher in colorectal cancer patients in comparison with the control group (55% versus 2. 5%). Furthermore the incidence of liver metastasis, peritoneal carcinomatosis, histopathologic lymph nodes metastasis, and tumor invasion in colorectal cancer patients with a preoperatively elevated serum CRP level were significantly more frequent than in those with a negative serum CRP level. The survival rates of colorectal cancer patients without a preoperative elevation of serum CRP proved to be significantly more favourable than what in colorectal cancer patients with such an elevation (94. 4% versus 59. 1%; P<0. 001).

Conclusions: A preoperative serum elevation of CRP was thus found to be an indicator of malignant potential of the tumor as well as a predictor for the prognosis of patients with colorectal cancer.