NATIONAL HARBOR, MD. – Elevated levels of C-reactive protein may be a marker for poor response to palliative surgery, Dr. Andrew M. Blakely said at the annual Society of Surgical Oncology Cancer Symposium.
In a study of 50 patients who underwent elective palliative procedures for various cancer-related symptoms, elevated C-reactive protein (CRP), but not fatigue scores or performance status, was associated with a nearly fourfold risk for worse overall survival, reported Dr. Blakely, a surgery resident at Alpert Medical School, Brown University, Providence, R.I.
Dr. Andrew Blakely
Elevated CRP, defined as levels greater than 8 mg/L, was also associated with increased overall and tumor-grade specific complications.
"This is important, because these complications are poorly tolerated by advanced cancer patients, and they serve to greatly diminish the potential benefit of palliative surgery," Dr. Blakely said.
He and colleagues at Brown and the Rhode Island Hospital, also in Providence, looked at potential prognostic factors in patients who chose surgery to relieve symptoms of advanced cancers such as gastrointestinal obstruction, or local-regional control of tumor-related pain or bleeding.
Malignancies treated included gastric, pancreatic, colon, melanoma, sarcomas, breast cancer, hepatobiliary and ovarian cancer, and squamous cell carcinomas.
They found that 44 patients (88%) stated that the surgery "was worth it," and 37 patients (74%) reported symptom resolution or improvement following surgery.
At 1-month follow-up, the complication rate was 44%, and 10% of patients had died. Although there was no association between CRP levels and morbidity or mortality among all patients, 11 of 27 patients with low-grade (grade 1 or 2) complications had elevated CRP (P = .001), as did all 6 patients with high-grade (grade 3 or 4) malignancies (P = .010), and 4 of 5 patients who died (P =.007).
In univariate analysis, factors significantly associated with major complications included elevated CRP (P = .005) and National Cancer Institute (NCI) fatigue score of 1 or greater (P = .001). Factors associated with overall survival were elevated CRP (P less than .0001), and NCI fatigue score (P = .04).
But in multivariate analysis controlling for those factors and for male sex, low albumin levels, significant weight loss, no previous cancer therapy, and hemoglobin less than 10.5 g/dL, only elevated CRP was associated with poor overall survival, with a hazard ratio of 3.6 (P = .0003).
The authors speculate that elevated CRP is a marker for systemic inflammation that may be associated with a higher risk for postoperative complications and for poorer overall survival among patients with advanced cancer.
"Even in this highly selected population, there was 44% morbidity and 10% mortality, illustrating the difficulty in patient selection," Dr. Blakely said.
CRP testing is a simple, low-cost, and objective test that can be easily added on to preoperative evaluation of candidates for palliative surgery, and it may be a useful element in patient selection and counseling, he said.
The study was internally funded. Dr. Blakely reported having no financial disclosures.