Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical Research

The prognostic role of preoperative serum C-reactive protein in predicting the biochemical recurrence in patients treated with radical prostatectomy

Prostate Cancer and Prostatic Diseases volume 19, pages 163–167 (2016)Cite this article

Subjects

Abstract

Background:

To assess the prognostic value of preoperative C-reactive protein (CRP) serum levels for prognostication of biochemical recurrence (BCR) after radical prostatectomy (RP) in a large multi-institutional cohort.

Methods:

Data from 7205 patients treated with RP at five institutions for clinically localized prostate cancer (PCa) were retrospectively analyzed. Preoperative serum levels of CRP within 24 h before surgery were evaluated. A CRP level ⩾0.5 mg dl−1 was considered elevated. Associations of elevated CRP with BCR were evaluated using univariable and multivariable Cox proportional hazards regression models. Harrel's C-index was used to assess prognostic accuracy (PA).

Results:

Patients with higher Gleason score on biopsy and RP, extracapsular extension, seminal vesicle invasion, lymph node metastasis, and positive surgical margins status had a significantly elevated preoperative CRP compared to those without these features. Patients with elevated CRP had a lower 5-year BCR survival proportion as compared to those with normal CRP (55% vs 76%, respectively, P<0.0001). In pre- and postoperative multivariable models that adjusted for standard clinical and pathologic features, elevated CRP was independently associated with BCR (P<0.001). However, the addition of preoperative CRP did not improve the accuracy of the standard pre- and postoperative models for prediction of BCR (70.9% vs 71% and 78.9% vs 78.7%, respectively).

Conclusions:

Preoperative CRP is elevated in patients with pathological features of aggressive PCa and BCR after RP. While CRP has independent prognostic value, it does not add prognostically or clinically significant information to standard predictors of outcomes.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Jemal A . Cancer statistics, 2015. CA Cancer J Clin 2015; 65: 5–29.

    Article  PubMed  Google Scholar 

  2. Abdollah F, Sun M, Thuret R, Jeldres C, Tian Z, Briganti A et al. A competing-risks analysis of survival after alternative treatment modalities for prostate cancer patients: 1988-2006. Eur Urol 2011; 59: 88–95.

    Article  PubMed  Google Scholar 

  3. Shariat SF, Karakiewicz PI, Roehrborn CG, Kattan MW . An updated catalog of prostate cancer predictive tools. Cancer 2008; 113: 3075–3099.

    Article  PubMed  Google Scholar 

  4. Bensalah K, Lotan Y, Karam JA, Shariat SF . New circulating biomarkers for prostate cancer. Prostate Cancer Prostatic Dis 2008; 11: 112–120.

    Article  CAS  PubMed  Google Scholar 

  5. Karam JA, Lotan Y, Roehrborn CG, Ashfaq R, Karakiewicz PI, Shariat SF . Caveolin-1 overexpression is associated with aggressive prostate cancer recurrence. Prostate 2007; 67: 614–622.

    Article  PubMed  Google Scholar 

  6. Pepys MB, Hirschfield GM . C-reactive protein: a critical update. J Clin Invest 2003; 111: 1805–1812.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Saito K, Kihara K . C-reactive protein as a biomarker for urological cancers. Nat Rev Urol 2011; 8: 659–666.

    Article  CAS  PubMed  Google Scholar 

  8. Gakis G, Todenhofer T, Renninger M, Schilling D, Sievert KD, Schwentner C et al. Development of a new outcome prediction model in carcinoma invading the bladder based on preoperative serum C-reactive protein and standard pathological risk factors: the TNR-C score. BJU Int 2011; 108: 1800–1805.

    Article  CAS  PubMed  Google Scholar 

  9. Hu Q, Gou Y, Sun C, Ding W, Xu K, Gu B et al. The prognostic value of C-reactive protein in renal cell carcinoma: a systematic review and meta-analysis. Urol Oncol 2014; 32: 50.e51–58.

    Article  Google Scholar 

  10. de Martino M, Klatte T, Seemann C, Waldert M, Haitel A, Schatzl G et al. Validation of serum C-reactive protein (CRP) as an independent prognostic factor for disease-free survival in patients with localised renal cell carcinoma (RCC). BJU Int 2013; 111: E348–E353.

    Article  CAS  PubMed  Google Scholar 

  11. Prins RC, Rademacher BL, Mongoue-Tchokote S, Alumkal JJ, Graff JN, Eilers KM et al. C-reactive protein as an adverse prognostic marker for men with castration-resistant prostate cancer (CRPC): confirmatory results. Urol Oncol 2012; 30: 33–37.

    Article  CAS  PubMed  Google Scholar 

  12. Ito M, Saito K, Yasuda Y, Sukegawa G, Kubo Y, Numao N et al. Prognostic impact of C-reactive protein for determining overall survival of patients with castration-resistant prostate cancer treated with docetaxel. Urology 2011; 78: 1131–1135.

    Article  PubMed  Google Scholar 

  13. Xu L, Zhao Q, Huang S, Li S, Wang J, Li Q . Serum C-reactive protein acted as a prognostic biomarker for overall survival in metastatic prostate cancer patients. Tumour Biol 2014; 36: 669–673.

    Article  PubMed  Google Scholar 

  14. Pond GR, Armstrong AJ, Wood BA, Leopold L, Galsky MD, Sonpavde G . Ability of C-reactive protein to complement multiple prognostic classifiers in men with metastatic castration resistant prostate cancer receiving docetaxel-based chemotherapy. BJU Int 2012; 110 (Pt B): E461–E468.

    Article  CAS  PubMed  Google Scholar 

  15. Liu ZQ, Chu L, Fang JM, Zhang X, Zhao HX, Chen YJ et al. Prognostic role of C-reactive protein in prostate cancer: a systematic review and meta-analysis. Asian J Androl 2014; 16: 467–471.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hall WA, Nickleach DC, Master VA, Prabhu RS, Rossi PJ, Godette K et al. The association between C-reactive protein (CRP) level and biochemical failure-free survival in patients after radiation therapy for nonmetastatic adenocarcinoma of the prostate. Cancer 2013; 119: 3272–3279.

    Article  CAS  PubMed  Google Scholar 

  17. Thurner EM, Krenn-Pilko S, Langsenlehner U, Stojakovic T, Pichler M, Gerger A et al. The elevated C-reactive protein level is associated with poor prognosis in prostate cancer patients treated with radiotherapy. Eur J Cancer 2015; 51: 610–619.

    Article  CAS  PubMed  Google Scholar 

  18. McArdle PA, Qayyum T, McMillan DC . Systemic inflammatory response and survival in patients with localised prostate cancer: 10-year follow-up. Urol Int 2010; 84: 430–435.

    Article  CAS  PubMed  Google Scholar 

  19. Graff JN, Beer TM, Liu B, Sonpavde G, Taioli E . Pooled Analysis of C-Reactive Protein Levels and Mortality in Prostate Cancer Patients. Clin Genitourin Cancer 2015; 13: e217–e221.

    Article  PubMed  Google Scholar 

  20. Mortensen RF . C-reactive protein, inflammation, and innate immunity. Immunol Res 2001; 24: 163–176.

    Article  CAS  PubMed  Google Scholar 

  21. Shariat SF, Kattan MW, Traxel E, Andrews B, Zhu K, Wheeler TM et al. Association of pre- and postoperative plasma levels of transforming growth factor beta(1) and interleukin 6 and its soluble receptor with prostate cancer progression. Clin Cancer Res 2004; 10: 1992–1999.

    Article  CAS  PubMed  Google Scholar 

  22. Bensalah K, Montorsi F, Shariat SF . Challenges of cancer biomarker profiling. Eur Urol 2007; 52: 1601–1609.

    Article  PubMed  Google Scholar 

  23. Lughezzani G, Briganti A, Karakiewicz PI, Kattan MW, Montorsi F, Shariat SF et al. Predictive and prognostic models in radical prostatectomy candidates: a critical analysis of the literature. Eur Urol 2010; 58: 687–700.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Stephenson AJ, Scardino PT, Eastham JA, Bianco FJ Jr, Dotan ZA, DiBlasio CJ et al. Postoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Clin Oncol 2005; 23: 7005–7012.

    Article  PubMed  Google Scholar 

  25. Stephenson AJ, Scardino PT, Eastham JA, Bianco FJ Jr, Dotan ZA, Fearn PA et al. Preoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Natl Cancer Inst 2006; 98: 715–717.

    Article  PubMed  Google Scholar 

  26. Shariat SF, Karam JA, Walz J, Roehrborn CG, Montorsi F, Margulis V et al. Improved prediction of disease relapse after radical prostatectomy through a panel of preoperative blood-based biomarkers. Clin Cancer Res 2008; 14: 3785–3791.

    Article  CAS  PubMed  Google Scholar 

  27. Jabs WJ, Busse M, Kruger S, Jocham D, Steinhoff J, Doehn C . Expression of C-reactive protein by renal cell carcinomas and unaffected surrounding renal tissue. Kidney Int 2005; 68: 2103–2110.

    Article  CAS  PubMed  Google Scholar 

  28. Shariat SF, Kattan MW, Erdamar S, Nguyen C, Scardino PT, Spencer DM et al. Detection of clinically significant, occult prostate cancer metastases in lymph nodes using a splice variant-specific rt-PCR assay for human glandular kallikrein. J Clin Oncol 2003; 21: 1223–1231.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

RM is supported by the scholarship foundation of the Republic of Austria—OeAD and by the EUSP Scholarship—European Association of Urology.

Author information

Author notes

  1. S Sevcenco and R Mathieu: These authors contributed equally as co-first authors.

Authors and Affiliations

  1. Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria

    S Sevcenco, R Mathieu, T Klatte, H Fajkovic, C Seitz & S F Shariat

  2. Department of Urology, Rennes University Hospital, Rennes, France

    R Mathieu

  3. Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria

    P Baltzer

  4. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada

    P I Karakiewicz

  5. Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France

    M Rouprêt

  6. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    M Rink & L Kluth

  7. School of Medicine, Sacramento, CA, USA

    Q-D Trinh

  8. Department of Surgery, Division of Urology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

    Q-D Trinh

  9. Department of Urology, Krankenhaus der Barmherzigen Schwestern, Linz, Austria

    W Loidl

  10. Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy

    A Briganti

  11. Department of Urology, Weill Cornell Medical College, New York, NY, USA

    D S Scherr & S F Shariat

  12. Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA

    S F Shariat

Authors
  1. S Sevcenco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R Mathieu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P Baltzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T Klatte
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H Fajkovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C Seitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P I Karakiewicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M Rouprêt
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M Rink
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. L Kluth
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Q-D Trinh
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. W Loidl
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. A Briganti
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. D S Scherr
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. S F Shariat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S F Shariat.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sevcenco, S., Mathieu, R., Baltzer, P. et al. The prognostic role of preoperative serum C-reactive protein in predicting the biochemical recurrence in patients treated with radical prostatectomy. Prostate Cancer Prostatic Dis 19, 163–167 (2016). https://doi.org/10.1038/pcan.2015.60

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/pcan.2015.60

This article is cited by

Search

Advanced search

Quick links