The clinical value of C-reactive protein and its association with tumour location in patients undergoing curative surgery for colorectal cancer – a ScotScan collaborative study

Abstract

Introduction

The presence of preoperative systemic inflammatory response (SIR) is an established negative prognostic factor for patients diagnosed with colorectal cancer (CRC). C-reactive protein (CRP) is known to be implicated in detrimental immune responses. The biological differences between right-sided and left-sided CRC are gaining increasing attention. Our aim was to analyse the prognostic value of CRP and explore the association between tumour location and SIR.

Material and methods

A total of 2059 patients treated for stage I–III CRC, identified from the prospectively sampled ScotScan Collaborative dataset, were included. The clinical and prognostic value of five CRP levels (<10/11–30/31–60/61–100/>100 mg/l) were examined. Additionally, the relationship between SIR and tumour location was explored.

Results

Increasing levels of CRP were associated with impaired overall and cancer-specific outcome. Presence of SIR was independently associated with right-sided tumour location (p<0.001). However, the impact of SIR on cancer-specific survival (CSS) was greater for left-sided tumour location, even when adjusted for other clinicopathological factors.

Conclusions

This study confirms CRP as a routinely available, valid, and clinically relevant strong prognostic marker of SIR in CRC patients. Right-sided tumours were more often associated with SIR, but the prognostic impact was stronger in left-sided tumours.

Keywords:

• Colorectal cancer
• systemic inflammation
• tumour location
• C-reactive protein

Acknowledgements

We thank Bente Mirjam Christensen for her dedicated and extensive work in maintaining and preserving the Sørlandet Hospital Colorectal Cancer Dataset.

Ethical approval

Local Institutional approval was granted for use of data from both Glasgow Royal Infirmary (West Scotland Ethics Committee) and Centre for Cancer Treatment Sørlandet Hospital. The study was performed in accordance with the Declaration of Helsinki.

Author contributions

A.J.F wrote the original draft of the article, as well as revised/edited and approved the final article, assembled data, and performed statistical analyses and interpretation. S.M. participated in revision and editing of the original draft of the article, as well as interpretation of statistical analyses. A.H.R. performed revision and editing of the first draft of the article. D.C.M. designed the study, assembled, and interpreted data, as well as revised and edited the first draft of the article. J.H.P. designed the study, participated in revision and editing of the first draft of the article, in addition to assembling data. C.K. designed the study, collected and interpreted data, as well as revised and edited the first draft of the article. All authors revised and authorised the final submitted draft of the manuscript.

Disclosure statement

A.J.F. has received honoraria from Novartis. No potential conflict of interest was reported by the author(s).

Data availability statement

Anonymised data for this study are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by the South-Eastern Norway Regional Health Authority [grant 2019109] (to A.H.R).