Elevated CRP levels predict poor outcome and tumor recurrence in patients with thymic epithelial tumors: A pro- and retrospective analysis
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Stefan Janik1,2, Christine Bekos1,2, Philipp Hacker1,2, Thomas Raunegger1,2, Bahil Ghanim1, Elisa Einwallner3, Lucian Beer2,4, Walter Klepetko1, Leonhard Müllauer5, Hendrik J. Ankersmit1,2 and Bernhard Moser1
1Department of Thoracic Surgery, Division of Surgery, Medical University of Vienna, Vienna, Austria
2Christian Doppler Laboratory for Diagnosis and Regeneration of Cardiac and Thoracic Diseases, Medical University of Vienna, Vienna, Austria
3Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
4Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
5Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
Bernhard Moser, email: firstname.lastname@example.org
Keywords: thymic epithelial tumors, thymoma, thymic carcinoma, CRP, prognosis
Received: November 11, 2016 Accepted: April 12, 2017 Published: April 27, 2017
Objective: Scarce information exists on the pathogenesis of thymic epithelial tumors (TETs), comprising thymomas, thymic carcinomas (TCs) and neuroendocrine tumors. C-reactive protein (CRP) increases during certain malignancies. We aimed to investigate the clinical relevance of CRP in patients with TETs.
Results: Pretreatment CRP serum concentrations were significantly elevated in patients with TETs, particularly TCs and metastatic TETs. After complete tumor resection CRP serum concentrations were decreased (p = 0.135) but increased significantly in case of tumor recurrence (p = 0.001). High pretreatment CRP was associated with significantly worse 5- and 10-year freedom-from recurrence (FFR) (p = 0.010) and was a negative prognostic factor for FFR (HR 3.30; p = 0.015). IL-6 (not IL-1β) serum concentrations were significantly elevated in patients with TETs but we did not detect CRP tissue expression in TETs.
Materials and Methods: Pretreatment CRP serum concentrations were retrospectively analyzed from 128 surgical patients (1990–2015). In a subset of 68 patients longitudinal analysis of CRP was performed. Additionally, immunohistochemical tumor CRP expression and serum concentrations of interleukin (IL)-6 and IL-1β were measured.
Conclusions: Hence, diagnostic measurement of serum CRP might be useful to indicate highly aggressive TETs and to make doctors consider tumor recurrences during oncological follow-up.
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