Prognostic Significance of C-Reactive Protein and Smoking in Patients with Advanced Non-small Cell Lung Cancer Treated with First-Line Palliative Chemotherapy

Hypothesis: The objective of the Study was to analyze if C-reactive protein (CRP) and smoking status provide prognostic information in patients with advanced non-small cell lung cancer (NSCLC) receiving palliative first-line chemotherapy. Methods: Retrospective, single-institutional study, comprising all patients with NSCLC stage IIIB/IV and World Health Organization performance status (PS) 0-2 who started palliative first-line chemotherapy between January 1, 2002, and January 3 1, 2007. Patient records were reviewed. Cox's proportional hazards model was used to identify prognostic factors. Results: Two hundred eight-nine consecutive patients were evaluable. Sixty-eight percent had stage IV disease and 67% had PS 0 or 1. Median survival was 7.4 months. At onset of chemotherapy, 206 patients (71%) had elevated CRP values (>= 10 mg/liter). One-hundred-forty-four patients (50%) were Current smokers. On Univariate analysis, patients with elevated CRP levels had inferior survival (hazard ratio [HR] = 1.67, 95% confidence interval [CI], 1.28-2.19, p < 0.001). Smoking at onset of treatment was associated with shorter survival (FIR 1.56, 95% Cl, 1.22-1.98, p < 0.001). Ever smokers had shorter Survival than never smokers (HR 1.80, 95% Cl, 1.25-2.59, p = 0.001). On multivariate analysis, with stage, PS, albumin, and gender as covariates, both smoking at start of chemotherapy and CRP elevation were independent negative prognostic factors for survival. Conclusions: CRP and smoking status are independent prognostic factors for survival in patients with advanced NSCLC receiving palliative first-line chemotherapy and provide additional information to established prognostic factors such as stage of disease and performance status.