Effect of CRP and Kinetics of CRP in Prognosis of Nasopharyngeal Carcinoma
Effect of CRP and Kinetics of CRP in Prognosis of Nasopharyngeal Carcinoma
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CRP及其动力学对鼻咽癌预后的影响
DOI：
10.3389/fonc.2019.00089
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发表时间：
2019-02-21
影响因子：
4.7
通讯作者：
Ren, Yufeng
中科院分区：
文献类型：
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作者：
Chen, Ruiwan;Zhou, Yu;Ren, Yufeng
基线C反应蛋白（CRP）已被确定为鼻咽癌（NPC）的预后因素。本研究旨在进一步评估CRP动力学对NPC患者的影响。方法回顾性分析2001年2月至2011年6月收治的1378例鼻咽癌患者的临床资料。分别于治疗开始、治疗中、治疗结束时检测CRP。终点为总生存期（OS）和无远处转移生存期（DMFS）。根据基线CRP和CRP动力学将患者分为3组：（1）持续正常组：基线CRP正常且从未升高的患者;（2）持续升高组：无论时间点CRP均升高的患者;（3）持续升高组：基线CRP升高且从未恢复正常的患者。基线CRP、治疗后CRP、CRP动力学与TNM分期、T分期、N分期相关。单因素和多因素分析表明，基线CRP升高和治疗后CRP与CRP正常者相比，生存率更差。治疗期间CRP升高与生存率无关。CRP持续升高的患者OS和DMFS均较差（HR：2.610，95%CI：1.592-4.279，p < 0.001; HR：2.816，95%CI：1.486-5.302，p = 0.001）。在多变量分析中，CRP动力学评估是NPC患者OS和DFMS的独立预后因素（HR：2.512，95%CI：1.452-4.346，p = 0.001; HR：3.389，95%CI：1.734-6.625，p = 0.001）。结论：治疗前和治疗后CRP升高是鼻咽癌预后不良的预测因素。CRP动力学研究表明，CRP在治疗过程中持续升高可能提示NPC预后不良。
Baseline C-reactive protein (CRP) has been determined as a prognostic factor in nasopharyngeal carcinoma (NPC). This study was designed to further evaluate the impact of CRP kinetics on NPC patients. Thousand three hundred and seventy eight NPC patients from February 2001 to June 2011 were retrospectively reviewed. CRP were measured at beginning, middle, and the end of the treatment. The endpoints were overall survival (OS) and distant metastasis free survival (DMFS). Patients were divided into three groups according to baseline CRP and CRP kinetics: (1) continuously normal group: patients whose baseline CRP normal and never elevated, (2) ever-elevated group: patients whose CRP ever elevated regardless time points, (3) continuously elevated group: patients whose baseline CRP elevated and never normalized. Baseline CRP, CRP after treatment, and CRP kinetics were correlated with TNM stage, T stage, and N stage. Univariate and multivariate analysis identified that elevated baseline CRP and CRP after treatment had significant association with worse survival than normal CRP. Oppositely, elevated CRP during treatment was not associated with survival. Patients with continuously elevated CRP significantly had poor OS and DMFS (HR:2.610, 95%CI: 1.592–4.279, p < 0.001; HR:2.816, 95%CI: 1.486–5.302, p = 0.001, respectively). In multivariate analysis, CRP kinetics assessment is an independent prognostic factor for OS and DFMS in NPC patients (HR:2.512, 95%CI: 1.452–4.346, p = 0.001; HR:3.389, 95%CI: 1.734–6.625, p = 0.001, respectively). In conclusion, elevated CRP at baseline and after treatment are predictive factors of poor prognosis for NPC. The study of CRP kinetics shows that continuously elevated CRP during treatment might indicate an unfavorable prognosis for NPC.