Acute-phase protein response, survival and tumour recurrence in patients with colorectal cancer

Introduction: An acute-phase protein response (APPR) has been associated wi th reduced crude survival rates and increased recurrence following apparent ly curative resection in patients with colorectal cancer. This study invest igated the prognostic significance of a preoperative and postoperative APPR in relation to disease-specific mortality rate. Methods: Some 202 patients with colorectal cancer were followed for at leas t 5 years. C-reactive protein concentration, measured before and at 3 month s after operation, was used as an index of the APPR. Univariate and multiva riate analyses were performed on a number of potential prognostic factors. Results: Thirty-six per cent of patients had an APPR and this was associate d with a higher rate of local tumour invasion, fewer curative resections an d a higher carcinoembryonic antigen (CEA) concentration. There was no diffe rence in Dukes' stage between patients with or without an APPR. The most im portant prognostic factor related to both disease-specific and crude surviv al was Duke's stage (P < 0.0001). Subgroup analysis demonstrated that APPR had prognostic significance only in patients with advanced disease (P = 0.0 13). An APPR was present in a minority of patients (11 per cent) after oper ation and was not associated with increased likelihood of tumour recurrence . Conclusion: The APPR is increased in more than a third of patients presenti ng with colorectal cancer and is associated with more frequent local tumour invasion, fewer curative resections and a higher CEA level. An APPR at 3 m onths after operation does not have the prognostic significance reported by earlier studies.