C-Reactive Protein, Lipid-soluble Micronutrients, and Survival in Colorectal Cancer Patients

Background: Identification of biomarkers associated with survival in patients with cancer is important for elucidating the underlying mechanisms of cancer progression and identifying possible interventions to reduce cancer morbidity and mortality. Methods: Using stored patient plasma samples from a multiethnic population- based case-control study of invasive colorectal cancer, we measured posttreatment blood levels of C- reactive protein (CRP) and lipid-soluble micronutrients. Patients (n - 368) were followed after phlebotomy (mean of 8 years), during which time 47% died (25% colorectal cancer specific). HRs were estimated by Cox proportional hazards regression with adjustment for stage, age at diagnosis, ethnicity, sex, smoking status, and month of blood draw. Results: A positive association with overall risk of death was observed for CRP [HR for highest vs. lowest quintile: 1.80; 95% confidence interval (CI), 1.07-3.04; P-trend - 0.01], whereas inverse associations were generally observed for retinol and carotenoids (HRs for overall risk of death for the highest quintile ranging from 0.5-0.8); these associations were significant for retinol (P-trend = 0.0002), alpha-carotene (P-trend = 0.02), and total carotenoids (P-trend = 0.02) and were generally consistent across subgroups (sex, ethnicity, cancer anatomical subtype, and stage). HRs for retinol and carotenoids were attenuated somewhat after adjustment for CRP. Similar trends for CRP were observed for colorectal cancer- specific deaths (HR for highest vs. lowest tertile: 2.06; 95% CI, 1.18-3.61; P-trend = 0.01) as for deaths from all other causes (P-heterogeneity = 0.78). Conclusions: These observations are consistent with a direct relationship between circulating CRP and overall survival among patients with colorectal cancer. Impact: These results, if reproduced, suggest that reduction of inflammation should be explored as a potential complementary treatment strategy. (c) 2013 AACR.