Pretreatment Serum C-Reactive Protein Levels Predict Benefit From Multimodality Treatment Including Radical Surgery in Malignant Pleural Mesothelioma A Retrospective Multicenter Analysis

被引:41
作者
Ghanim, Bahil [1 ,6 ]
Hoda, Mir Alireza [1 ,6 ]
Winter, Max-Paul [1 ]
Klikovits, Thomas [1 ]
Alimohammadi, Arman [1 ]
Hegedus, Balazs [1 ,2 ,6 ]
Dome, Balazs [1 ,3 ]
Grusch, Michael [2 ,6 ]
Arns, Madeleine [4 ]
Schenk, Peter [4 ]
Pohl, Wolfgang [5 ]
Zielinski, Christoph [2 ,6 ]
Filipits, Martin [2 ,6 ]
Klepetko, Walter [1 ,6 ]
Berger, Walter [2 ,6 ]
机构
[1] Med Univ Vienna, Dept Surg, Div Thorac Surg, A-1090 Vienna, Austria
[2] Med Univ Vienna, Dept Med 1, Inst Canc Res, A-1090 Vienna, Austria
[3] Natl Koranyi Inst TB & Pulmonol, Budapest, Hungary
[4] LKH Hochegg, Dept Pulmonol, Hochegg, Austria
[5] Karl Landsteiner Inst Clin & Expt Pneumol, KH Hietzing, Dept Pneumol, Vienna, Austria
[6] Med Univ Vienna, Ctr Comprehens Canc, A-1090 Vienna, Austria
关键词
malignant pleural mesothelioma; C-reactive protein; biomarkers; prognostic; predictive; multimodality therapy; CELL LUNG-CANCER; SYSTEMIC INFLAMMATORY RESPONSE; PROGNOSTIC-FACTORS; EXTRAPLEURAL PNEUMONECTOMY; TRIMODALITY THERAPY; COLORECTAL-CANCER; SURVIVAL; CARCINOMA; CHEMOTHERAPY; ADENOCARCINOMA;
D O I
10.1097/SLA.0b013e3182602af4
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: To evaluate the prognostic and predictive relevance of pretreatment serum C-reactive protein (CRP) in malignant pleural mesothelioma (MPM) patients. Background: MPM is a rare but aggressive disease with poor treatment outcome. Therapeutic decision is challenging, and predictive biomarkers for better treatment stratification are urgently needed. Methods: Clinical data, including survival and pretreatment CRP levels, were retrospectively collected from 115 patients with histologically proven MPM. Patients with any evidence for infectious disease were excluded. The association between CRP levels and survival was analyzed using Cox models adjusted for clinical and pathological factors. Results: Median pretreatment CRP of all patients was 1.19 mg/dL (range: 0.00-22.62 mg/dL). Patients with elevated CRP levels (>= 1 mg/dL; n = 62, 53.9%) had a significantly shorter overall survival compared with those with normal CRP (hazard ratio [HR] 2.81, 95% confidence interval [CI] 1.82-4.33; P < 0.001). In multivariate survival analyses, elevated CRP was confirmed as an independent prognostic factor in MPM (HR 2.07, 95% CI 1.23-3.46; P = 0.01). Most interestingly, we observed a significant interaction between CRP and treatment modality (P < 0.001). Among patients with normal CRP levels, radical tumor resection within multimodality therapy was associated with distinctly prolonged overall survival when compared with treatment protocols without surgery (HR 7.26, 95% CI 3.40-15.49; P < 0.001). In contrast among patients with elevated CRP, no survival benefit was achieved by radical surgery within multimodality approaches (HR 0.911, 95% CI 0.53-1.58; P = 0.74). Conclusions: Our results suggest that multimodality regimens including radical resection increase survival selectively in MPM patients with normal pretreatment serum CRP levels.
引用
收藏
页码:357 / 362
页数:6
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