Clinical Epidemiology (Jun 2023)

Prognostic Value of Post-Operative C-Reactive Protein-Based Inflammatory Biomarkers in Colorectal Cancer Patients: Systematic Review and Meta-Analysis

  • Gwenzi T,
  • Zhu A,
  • Schrotz-King P,
  • Schöttker B,
  • Hoffmeister M,
  • Edelmann D,
  • Brenner H

Journal volume & issue
Vol. Volume 15
pp. 795 – 809

Abstract

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Tafirenyika Gwenzi,1,2 Anna Zhu,2,3 Petra Schrotz-King,1 Ben Schöttker,3 Michael Hoffmeister,3 Dominic Edelmann,4 Hermann Brenner1,3,5,6 1Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, 69120, Germany; 2Medical Faculty Heidelberg, Heidelberg University, Heidelberg, 69120, Germany; 3Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, 69120, Germany; 4Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, 69120, Germany; 5Network Aging Research, Heidelberg University, Heidelberg, 69115, Germany; 6German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, 69120, GermanyCorrespondence: Hermann Brenner, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Heidelberg, 69120, Germany, Tel +49 6221 42 1300, Fax +49-6221 42 1302, Email [email protected]: Post-operative inflammation in cancer patients can be modulated by drugs and diets, but evidence on its prognostic role, which would be crucial for personalized treatment and surveillance schemes, remains rather limited. We aimed to systematically review and meta-analyse studies on the prognostic value of post-operative C-reactive protein (CRP)-based inflammatory biomarkers among patients with colorectal cancer (CRC) (PROSPERO#: CRD42022293832). PubMed, Web of Science and Cochrane databases were searched until February 2023. Studies reporting associations between post-operative CRP, Glasgow Prognostic Score (GPS) or modified Glasgow Prognostic Score (mGPS) with overall survival (OS), CRC-specific survival (CSS) and recurrence-free survival (RFS) were included. Hazard ratios (HRs) with 95% confidence intervals (CIs) for the predictor-outcome associations were pooled using R-software, version 4.2. Sixteen studies (n = 6079) were included in the meta-analyses. Elevated post-operative CRP was a predictor of poor OS, CSS and RFS compared with low CRP levels [HR (95% CI): 1.72 (1.32– 2.25); 1.63 (1.30– 2.05); 2.23 (1.44– 3.47), respectively]. A unit increase in post-operative GPS predicted poor OS [HR (95% Cl): 1.31 (1.14– 1.51)]. Moreover, a unit increase in post-operative mGPS was associated with poor OS and CSS [HR (95% Cl): 1.93 (1.37– 2.72); 3.16 (1.48– 6.76), respectively]. Post-operative CRP-based inflammatory biomarkers have a significant prognostic role for patients with CRC. Prognostic value of these easy-to-obtain routine measurements thereby seems to outperform most of the much more complex blood- or tissue-based predictors in the current focus of multi-omics-based research. Future studies should validate our findings, establish optimal time for biomarker assessment and determine clinically useful cut-off values of these biomarkers for post-operative risk-stratification and treatment-response monitoring.Keywords: C-reactive protein, survival, assess, risk-stratification, treatment-response

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