Elevated Preoperative C-Reaction Protein Associated with Worse Survival in Patients Undergoing Palliative Procedures

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(ChemotherapyAdvisor) – Elevated preoperative C-reaction protein (CRP) may help identify patients with advanced cancer who are less likely to benefit from palliative procedures, according to results of a study presented at the 66th Annual Society of Surgical Oncology (SSO) Cancer Symposium, held in National Harbor, MD.

“Systemic inflammation, reflected by elevated CRP, may be associated with higher risk of postoperative complications and poorer overall survival” in patients with advanced cancer, Andrew M. Blakely, MD, of Rhode Island Hospital, Providence, RI, and colleagues reported.

To date, limited outcomes data are available to guide optimal surgical decision-making and informed consent for palliative procedures. For example, “decreased performance status, poor nutrition, significant weight loss, and no prior cancer therapy have been associated with worse patient outcomes; however, patient selection continues be challenging for even the most experienced surgeons.”

Since several reports have shown CRP to be associated with major primary oncologic surgical outcomes, the investigators analyzed the role of CRP in palliative operations. They identified procedures to palliate symptoms of advanced cancer from a prospective palliative surgery database. “Patients with a recorded preoperative serum CRP (normal 0-8 mg/L) were identified and observed for at least 90 days or until death.”

Of the 50 patients identified who underwent an elective palliative procedure from July 2008 to June 2012, 35% had an operation for gastrointestinal obstruction, 28% for locoregional control of tumor-related symptoms such as pain, 7% for bleeding, and 30% for other reasons. Following 37 (74%) of the procedures, patients reported symptom resolution or improvement.

At 30 days postoperatively, palliative procedures were associated with a 42% morbidity rate and a 10% mortality rate.

In 27 patients, CRP was elevated; median CRP was 9.6 mg/L (range 1-144 mg/L), which was independently associated with developing a high-grade complication (P=0.008), Dr. Blakely reported. In patients with an elevated versus a nonelevated CRP, median survival was significantly decreased (167 vs. 592 days; P=0.014).

On multivariate analysis, only elevated preoperative CRP (P<0.017) was found to be associated with worse overall survival. National Cancer Institute fatigue score 1 or higher (P=0.08) and Eastern Cooperative Oncology Group performance status of 2 or higher (P=0.47) were not associated with worse overall survival.

“Highly selected patients with advanced cancer can be afforded symptom improvement and the opportunity for improved quality of life following palliative procedures,” Dr. Blakely concluded.

The abstract (#59) for this presentation is available at the 66th Annual SSO Cancer Symposium's website.

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