The impact of baseline serum C-reactive protein and C-reactive protein kinetics on the prognosis of metastatic nasopharyngeal carcinoma patients treated with palliative chemotherapy

Wei-Xiong Xia, Yan-Fang Ye, Xing Lu, Lin Wang, Liang-Ru Ke, Hai-Bo Zhang, Mark D Roycik, Jing Yang, Jun-Li Shi, Ka-Jia Cao, Xiang Guo, Yan-Qun Xiang, Wei-Xiong Xia, Yan-Fang Ye, Xing Lu, Lin Wang, Liang-Ru Ke, Hai-Bo Zhang, Mark D Roycik, Jing Yang, Jun-Li Shi, Ka-Jia Cao, Xiang Guo, Yan-Qun Xiang

Abstract

Background: The aim of this study was to determine whether baseline C-reactive protein (CRP) levels and CRP kinetics predict the overall survival in metastatic nasopharyngeal carcinoma (mNPC) patients.

Methods: A total of 116 mNPC patients from January 2006 to July 2011 were retrospectively reviewed. Serum CRP level was measured at baseline and thereafter at the start of each palliative chemotherapy cycle for all patients.

Results: Patients with higher values of baseline CRP (≥ 3.4 mg/L) had significantly worse survival than those with lower baseline CRP values (< 3.4 mg/L). Patients were divided into four groups according to baseline CRP and CRP kinetics: (1) patients whose CRP < 3.4 mg/L and never elevated during treatment; (2) patients whose CRP < 3.4 mg/L and elevated at least one time during treatment; (3) patients whose CRP ≥ 3.4 mg/L and normalized at least one time during treatment; and (4) patients whose CRP ≥ 3.4 mg/L and never normalized during treatment. The patients were further assigned to non-elevated, elevated, normalized, and non-normalized CRP groups. Overall survival rates were significantly different among the four groups, with three-year survival rates of 68%, 41%, 33%, and 0.03% for non-elevated, elevated, normalized, and non-normalized CRP groups respectively. When compared with the non-elevated group, hazard ratios of death were 1.69, 2.57, and 10.34 in the normalized, elevated, and non-normalized groups (P < 0.001).

Conclusions: Baseline CRP and CRP kinetics may be useful to predict the prognosis of metastatic NPC patients treated with palliative chemotherapy and facilitate individualized treatment. A prospective study to validate this prognostic model is still needed however.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow chart of the different…
Figure 1. Flow chart of the different patients group according to C-reactive protein (CRP) kinetics.
Figure 2. The relationship between the baseline…
Figure 2. The relationship between the baseline serum C-reactive protein and plasma EBV-DNA copy.
(A) Correlation between baseline serum C-reactive protein and plasma EBV-DNA copy (P < 0.0001, r = 0.352). (B)The plasma EBV-DNA copy of NPC patients with higher baseline CRP levels was significantly higher than those with lower baseline CRP levels (P = 0.0001).
Figure 3. Kaplan-Meier analysis of overall survival…
Figure 3. Kaplan-Meier analysis of overall survival according to baseline C-reactive protein (CRP) levels.
(A) Overall survival in all patients according to baseline CRP levels (P < 0.0001). (B) Kaplan-Meier analysis of overall survival in one metastasis subgroup (P = 0.003). (C) Kaplan-Meier analysis of overall survival in multiple metastasis sites subgroup (P = 0.001). (D) Kaplan-Meier analysis of overall survival in metastasis after radical therapy subgroup (P = 0.007). (E) Kaplan-Meier analysis of overall survival in metastasis at presentation subgroup (P = 0.004). (F) Kaplan-Meier analysis of overall survival in bone metastasis subgroup (P = 0.0001). (G) Kaplan-Meier analysis of overall survival in liver subgroup (P = 0.003). (H) Kaplan-Meier analysis of overall survival in lung subgroup. The log-rank test was used to calculate P-values (P = 0.168).
Figure 4. Kaplan-Meier analysis of the overall…
Figure 4. Kaplan-Meier analysis of the overall survival regarding CRP kinetics.
Kaplan-Meier analysis of overall survival of non-elevated (CRP P < 0.0001).

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