Preresection serum C-reactive protein measurement and survival among patients with resectable non-small cell lung cancer

Objective: This study aimed to determine whether preresection serum CRP level independently predicts survival among patients with resectable non-small cell lung cancer. Methods: Clinical, pathologic, and laboratory data from 300 patients operated on for non-small cell lung cancer in a single institution were studied in univariate and multivariate survival analyses. Validation was sought in another cohort of 68 similar patients from another institution. Results: In the main cohort, preoperative CRP value was 3 mg/L or lower in 136 patients (45.3%), between 4 and 20 mg/L in 89 (29.7%), and greater than 20 in 64 (21.3%). CRP level was significantly associated with chronic bronchitis, hypoalbuminemia, pathologic stage, and peritumoral vascular emboli. Overall, 5-year survivals of patients with preoperative CRP 3 mg/L or lower, between 4 and 20 mg/L, and greater than 20 mg/L were 55.6%, 45.6%, and 40.0%, respectively (P = .0571). In multivariate analysis, CRP level greater than 20 was significantly associated with survival, but with significant interaction between CRP level and disease stage (P = .02). Patients in stage I or II disease with CRP levels greater than 20 had worse survival than did patients with undetectable CRP (adjusted hazard ratio, 1.874; 95% confidence interval, 1.039-3.381); the difference was not significant in stages III and IV. In the validation series, CRP level greater than 20 mg/L also predicted worse survival (P = .018). Conclusions: Preoperative CRP level greater than 20 mg/L is significantly associated with worse survival than undetectable CRP in patients with stage I or II non-small cell lung cancer. (J Thorac Cardiovasc Surg 2011;142:1161-7)