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High CRP values predict poor survival in patients with penile cancer.

Steffens S, Al Ghazal A, Steinestel J, Lehmann R, Wegener G, Schnoeller TJ, Cronauer MV, Jentzmik F, Schrader M, Kuczyk MA, Schrader AJ - BMC Cancer (2013)

Bottom Line: The Kaplan-Meier 5-year cancer-specific survival (CSS) rate was 38.9% for patients with preoperative CRP levels above 15 mg/l and 84.3% for those with lower levels (p=0.001).A high preoperative serum CRP level was associated with poor survival in patients with penile cancer.If larger patient populations confirm its prognostic value, its routine use could enable better risk stratification and risk-adjusted follow-up of patients with SCC of the penis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Urology, Hannover Medical School, Hannover, Germany. steffens.sandra@mh-hannover.de

ABSTRACT

Background: High levels of circulating C-reactive protein (CRP) have recently been linked to poor clinical outcome in various malignancies. The aim of this study was to evaluate the prognostic significance of the preoperative serum CRP level in patients with squamous cell carcinoma (SCC) of the penis.

Methods: This retrospective analysis included 79 penile cancer patients with information about their serum CRP value prior to surgery who underwent either radical or partial penectomy at two German high-volume centers (Ulm University Medical Center and Hannover Medical School) between 1990 and 2010. They had a median (mean) follow-up of 23 (32) months.

Results: A significantly elevated CRP level (>15 vs. ≤ 15 mg/l) was found more often in patients with an advanced tumor stage (≥pT2) (38.9 vs. 11.6%, p=0.007) and in those with nodal disease at diagnosis (50.0 vs. 14.6%, p=0.007). However, high CRP levels were not associated with tumor differentiation (p=0.53). The Kaplan-Meier 5-year cancer-specific survival (CSS) rate was 38.9% for patients with preoperative CRP levels above 15 mg/l and 84.3% for those with lower levels (p=0.001). Applying multivariate analysis and focusing on the subgroup of patients without metastasis at the time of penile surgery, both advanced local tumor stage (≥pT2; HR 8.8, p=0.041) and an elevated CRP value (>15 mg/l; HR 3.3, p=0.043) were identified as independent predictors of poor clinical outcome in patients with penile cancer.

Conclusions: A high preoperative serum CRP level was associated with poor survival in patients with penile cancer. If larger patient populations confirm its prognostic value, its routine use could enable better risk stratification and risk-adjusted follow-up of patients with SCC of the penis.

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Cancer-specific survival (Kaplan-Meier) of patients with penile SCC plotted against the preoperative CRP group. The 5-year survival rate of all evaluable patients (n=69) was 84.3% for CRP ≤15 mg/l (n=54) and 38.9% for CRP >15 mg/l (n=15) (p=0.001, log rank).
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Figure 1: Cancer-specific survival (Kaplan-Meier) of patients with penile SCC plotted against the preoperative CRP group. The 5-year survival rate of all evaluable patients (n=69) was 84.3% for CRP ≤15 mg/l (n=54) and 38.9% for CRP >15 mg/l (n=15) (p=0.001, log rank).

Mentions: Univariate Cox regression analysis showed that – in contrast to older age (>median; HR 0.52, 95% CI 0.16-1.73, p=0.30), elevated BMI (>25 kg/m2; HR 0.51, 95% CI 0.16-1.77, p=0.29), and even high tumor grade (≥G3; HR 1.63, 95% CI 0.48-5.49, p=0.43) - both high tumor stage (≥pT2; HR 17.16, 95% CI 2.21-133.34, p=0.007) and metastasis at diagnosis (HR 12.02, 95% CI 3.23-44.79, p<0.001) were associated with poor CSS. An elevated CRP value also proved to be a prognosticator of poor CSS, regardless of the cut-off level. However, using ROC analysis a CRP cut-off of 15 mg/l was found to be optimal for achieving high prognostic accuracy. Accordingly, with a hazard ratio (HR) of 5.58 (95% CI 1.79-17.42, p=0.003), the CRP cut-off of 15 mg/l was superior to alternative cut-offs of 5 mg/l (HR 3.55, 95% CI 1.07-11.85, p=0.039), 10 mg/l (HR 4.59, 95% CI 1.47-14.31, p=0.009), or 20 mg/l (HR 4.18, 95% CI 1.32-13.22, p=0.015). The 5-year survival rate of all evaluable patients (n=69) was 84.3% for CRP ≤15 mg/l (n=54) and 38.9% for CRP >15 mg/l (n=15; p=0.001, log rank; Figure 1).


High CRP values predict poor survival in patients with penile cancer.

Steffens S, Al Ghazal A, Steinestel J, Lehmann R, Wegener G, Schnoeller TJ, Cronauer MV, Jentzmik F, Schrader M, Kuczyk MA, Schrader AJ - BMC Cancer (2013)

Cancer-specific survival (Kaplan-Meier) of patients with penile SCC plotted against the preoperative CRP group. The 5-year survival rate of all evaluable patients (n=69) was 84.3% for CRP ≤15 mg/l (n=54) and 38.9% for CRP >15 mg/l (n=15) (p=0.001, log rank).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3649950&req=5

Figure 1: Cancer-specific survival (Kaplan-Meier) of patients with penile SCC plotted against the preoperative CRP group. The 5-year survival rate of all evaluable patients (n=69) was 84.3% for CRP ≤15 mg/l (n=54) and 38.9% for CRP >15 mg/l (n=15) (p=0.001, log rank).
Mentions: Univariate Cox regression analysis showed that – in contrast to older age (>median; HR 0.52, 95% CI 0.16-1.73, p=0.30), elevated BMI (>25 kg/m2; HR 0.51, 95% CI 0.16-1.77, p=0.29), and even high tumor grade (≥G3; HR 1.63, 95% CI 0.48-5.49, p=0.43) - both high tumor stage (≥pT2; HR 17.16, 95% CI 2.21-133.34, p=0.007) and metastasis at diagnosis (HR 12.02, 95% CI 3.23-44.79, p<0.001) were associated with poor CSS. An elevated CRP value also proved to be a prognosticator of poor CSS, regardless of the cut-off level. However, using ROC analysis a CRP cut-off of 15 mg/l was found to be optimal for achieving high prognostic accuracy. Accordingly, with a hazard ratio (HR) of 5.58 (95% CI 1.79-17.42, p=0.003), the CRP cut-off of 15 mg/l was superior to alternative cut-offs of 5 mg/l (HR 3.55, 95% CI 1.07-11.85, p=0.039), 10 mg/l (HR 4.59, 95% CI 1.47-14.31, p=0.009), or 20 mg/l (HR 4.18, 95% CI 1.32-13.22, p=0.015). The 5-year survival rate of all evaluable patients (n=69) was 84.3% for CRP ≤15 mg/l (n=54) and 38.9% for CRP >15 mg/l (n=15; p=0.001, log rank; Figure 1).

Bottom Line: The Kaplan-Meier 5-year cancer-specific survival (CSS) rate was 38.9% for patients with preoperative CRP levels above 15 mg/l and 84.3% for those with lower levels (p=0.001).A high preoperative serum CRP level was associated with poor survival in patients with penile cancer.If larger patient populations confirm its prognostic value, its routine use could enable better risk stratification and risk-adjusted follow-up of patients with SCC of the penis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Urology, Hannover Medical School, Hannover, Germany. steffens.sandra@mh-hannover.de

ABSTRACT

Background: High levels of circulating C-reactive protein (CRP) have recently been linked to poor clinical outcome in various malignancies. The aim of this study was to evaluate the prognostic significance of the preoperative serum CRP level in patients with squamous cell carcinoma (SCC) of the penis.

Methods: This retrospective analysis included 79 penile cancer patients with information about their serum CRP value prior to surgery who underwent either radical or partial penectomy at two German high-volume centers (Ulm University Medical Center and Hannover Medical School) between 1990 and 2010. They had a median (mean) follow-up of 23 (32) months.

Results: A significantly elevated CRP level (>15 vs. ≤ 15 mg/l) was found more often in patients with an advanced tumor stage (≥pT2) (38.9 vs. 11.6%, p=0.007) and in those with nodal disease at diagnosis (50.0 vs. 14.6%, p=0.007). However, high CRP levels were not associated with tumor differentiation (p=0.53). The Kaplan-Meier 5-year cancer-specific survival (CSS) rate was 38.9% for patients with preoperative CRP levels above 15 mg/l and 84.3% for those with lower levels (p=0.001). Applying multivariate analysis and focusing on the subgroup of patients without metastasis at the time of penile surgery, both advanced local tumor stage (≥pT2; HR 8.8, p=0.041) and an elevated CRP value (>15 mg/l; HR 3.3, p=0.043) were identified as independent predictors of poor clinical outcome in patients with penile cancer.

Conclusions: A high preoperative serum CRP level was associated with poor survival in patients with penile cancer. If larger patient populations confirm its prognostic value, its routine use could enable better risk stratification and risk-adjusted follow-up of patients with SCC of the penis.

Show MeSH
Related in: MedlinePlus