Table of Contents  
Year : 2014  |  Volume : 16  |  Issue : 3  |  Page : 467-471

Prognostic role of C-reactive protein in prostate cancer: a systematic review and meta-analysis

Department of Medical Oncology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China

Date of Submission27-Aug-2013
Date of Decision03-Oct-2013
Date of Acceptance02-Nov-2013
Date of Web Publication21-Feb-2014

Correspondence Address:
Qing Xu
Department of Medical Oncology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1008-682X.123686

Rights and Permissions

Several studies have reported that C-reactive protein (CRP), an inflammation biomarker, may be associated with the prognosis of prostate cancer (PCa). The objective of this systematic review is to summarize the predictive role of CRP for survival in PCa as reported in previous studies. Related studies were identified, and evaluated for quality through multiple search strategies. Data was collected from studies comparing overall and cancer-specific survival (CSS) in patients with elevated CRP levels and those having lower levels. However, for progression-free survival (PFS), data were collected according to the log of CRP. The hazard ratio (HR) and its 95% confidence interval (CI) were used to assess the strength of associations. A total of nine studies (n = 1,497) were evaluated in this meta-analysis (five for overall survival (OS), four for CSS and two for PFS). For OS and PFS, the pooled HR of CRP was statistically significant at 1.51 (95% CI, 1.28-1.79) and 1.50 (95% CI, 1.25-1.81), respectively. For CSS, the pooled HR was 1.91 (95% CI, 1.36-2.69) with higher CRP expression in PCa, which strongly indicates poorer survival in PCa. This study demonstrates that CRP may have a critical prognostic value in patients with prostatic cancer.

Keywords: C-reactive protein; meta-analysis; prognosis; prostate cancer

How to cite this article:
Liu ZQ, Chu L, Fang JM, Zhang X, Zhao HX, Chen YJ, Xu Q. Prognostic role of C-reactive protein in prostate cancer: a systematic review and meta-analysis. Asian J Androl 2014;16:467-71

How to cite this URL:
Liu ZQ, Chu L, Fang JM, Zhang X, Zhao HX, Chen YJ, Xu Q. Prognostic role of C-reactive protein in prostate cancer: a systematic review and meta-analysis. Asian J Androl [serial online] 2014 [cited 2021 Jul 29];16:467-71. Available from: - DOI: 10.4103/1008-682X.123686

Zhu.Qing Liu∗, Li Chu∗,
∗These authors contributed equally to this work.

  Introduction Top

Prostate cancer (PCa) is the most commonly diagnosed cancer and second leading cause of death in men. [1] While, many men present with localized and potentially curable disease, a large number of deaths from PCa is due to the development of metastatic disease. Therefore, more accurate prognosis and predictive markers should be applied for PCa to guide therapy and monitor disease progress in individual patients. It has been shown that pain, Gleason score, Eastern Cooperative Oncology Group Performance Status, presence of visceral metastases, hemoglobin, albumin and alkaline phosphatase are prognostic factors for overall survival (OS), [2],[3],[4],[5] and several other prognostic algorithms have also been proposed. [3],[4],[6],[7]

Recently, the presence of a systemic inflammatory response, which is measured by an acute-phase reactant has been identified to be associated with a poor prognosis in various types of cancers such as lung cancer, gastric cancer, colorectal cancer, renal cell carcinoma and others. [8],[9] C-reactive protein (CRP) is a typical acute-phase protein that is mainly produced by the hepatocytes, [10] and it can precipitate C-polysaccharide of Streptococcus pneumonia. [11] The association of CRP with survival was stronger than all other predictors, such as serum prostate-specific antigen, Eastern Cooperative Oncology Group Performance Status and age.

While some of the previous studies have reported that in PCa patients a higher CRP level was significantly associated with worse outcome in PCa, [12],[13] some other studies did not show any significant link between CRP and survival in PCa patients. [14] Therefore, it is essential to carry out a systematic meta-analysis to summarize the global results and address the inconsistencies in the literature. Here, we seek to conduct a systematic review and meta-analysis to evaluate the overall risk of elevated CRP and survival in PCa.

  Materials and Methods Top

This meta-analysis was carried out as per the guidelines of the MOOSE (Meta-analysis of Observational Studies in Epidemiology Group). [15]

Search strategy

A systematic literature search was performed in MEDLINE and EMBASE up to August 2013 to identify the relevant studies. An initial search strategy using recognized search terms (CRP or C-reactive protein, prognosis and prostate cancer or PCa) was conducted. Studies were considered eligible if they met the following criteria: (i) they measured pretreatment CRP values, (ii) they evaluated the potential association between pretreatment CRP and the survival outcome of PCa and (iii) prospective or retrospective study design. Articles were excluded based on the following criteria: (i) letters or review articles, (ii) laboratory studies and (iii) missing key information such as hazard ratio (HR) and 95% confidence interval (CI).

All searches were conducted independently by two reviewers. The identified studies were double-checked by both. Disagreements were resolved by consensus between the two readers or consultation with a third reviewer. Additionally, a manual search was performed using references from the relevant literature, including all of the identified studies, reviews and editorials. When duplicate studies were found, the study with reported HR or that involved more patients (usually the most recent), was used for the meta-analysis. This step was carried out to prevent overlapping between cohorts and overestimation of the overall HR.

Quality assessment

We systematically assessed the quality of all the studies included as per the crucial review checklist of the Dutch Cochrane Centre proposed by MOOSE. [15] The key points of the current checklist include: (i) clear definition of study population and origin of country; (ii) clear definition of study design; (iii) clear definition of outcome assessment, OS, cancer-specific survival (CSS) and progression-free survival (PFS); (iv) clear definition of cutoff for CRP or clear definition of log of CRP and (v) sufficient period of follow-up. Those studies which do not mention all these 5 points were excluded to avoid compromising the quality of the meta-analysis. A flow diagram of the study selection process is shown in [Figure 1].
Figure 1: Flow diagram of the study selection process. HR: hazard ratio.

Click here to view

Data extraction and conversion

The following data were collected: (i) publication details, including first author's last name, year of publication, study population and country in which the study was conducted; (ii) study design; (iii) characteristics of the studied population, including sample size, age and stage of disease and (iv) HR of elevated CRP for OS, CSS and PFS and their 95% CIs. The simplest method consisted of the direct collection of HR and their 95% CIs from the original literature, with an HR of > 1 being associated with a poorer outcome. When these data were not directly reported, we extracted the total number of observed deaths and the number of patients in each group to calculate HR. [16] Data were extracted from the graphical survival plots when data were available only as Kaplan-Meier curves, and then estimation of the HR was performed by the described method. [16]

Statistical analysis

The heterogeneity of the combined HRs was performed using Cochran's Q test and Higgins I-squared statistics. P < 0.05 was considered significant. We used the random effects model (Der Simonian and Laird method) if heterogeneity was observed (P < 0.05). The random effects model was also applied in the absence of between-study heterogeneity (P ≥ 0.05). Sensitivity analyses were performed to explore the reasons for heterogeneity among these studies. Publication bias was evaluated by the funnel plot with the Egger's bias indicator test. [17] Statistical analyses were carried out using the statistical software Stata version 12.0 (Stata CorpLP, College Station, TX, USA).

  Results Top

Data retrieval

Eighty-three records for CRP were identified after a primary search of PubMed and EMBASE. After reading the titles and abstractions, 73 studies were excluded for being review articles, letters, laboratory studies, studies with important data missing and studies irrelevant to the current analysis. For example, some studies analyzed the predictive value of other inflammatory factors such as interleukin-6, but not CRP. Some studies analyzed the CRP levels at one time point without follow-up to observe the outcome. One study was excluded because HR was missing. [14] The final meta-analysis for CRP was performed for the remaining nine studies [Figure 1]. [12],[13],[18],[19],[20],[21],[22],[23],[24] Notably, there were three publications that involved two studies. [21],[23],[24]

Study characteristics

The characteristics of selected studies are summarized in [Table 1]. We collected the data from nine studies, which involved a total of 1497 patients from the United Kingdom, Japan, Canada and the United States. In these nine studies, CRP values were analyzed by different means in each study. Five studies dealt with CRP as a dichotomous variable, with different cutoff values. One study dealt with CRP as a trichotomous variable and compared the outcome of the highest tertile with the lowest tertile. In the remaining three studies, CRP was considered as a continuous variable and HR was calculated as a unit change on a log scale. All the nine selected studies presented HRs. The median follow-up period in all the studies ranged from 9.4 to 142.8 months.
Table 1: Summery table of the meta-analysis

Click here to view

Overall survival

In the studies evaluating the OS, there was no evidence for significant heterogeneity between studies for categorized CRP (P = 0.317). The random model was applied to calculate the pooled HR and its 95% CI. The increased serum CRP level was significantly correlated to OS with a pooled HR estimate of 1.51 (95% CI, 1.28-1.79) [Figure 2]. For log CRP, there was some evidence for heterogeneity (I 2 = 73.5, P = 0.052), and the pooled HR and 95% CI were not significant at 1.21 (0.98-1.49) [Figure 2].
Figure 2: Forest plots of studies evaluating hazard ratios (HR) with 95% confidence interval (95% CI) for high C-reactive protein (CRP) levels as compared with low levels. Survival data are reported as overall survival (OS), cancer-specific survival (CSS) and progression-free survival (PFS).

Click here to view

Cancer-specific survival and progression-free survival

For CSS and PFS, a random effects model was applied. The P values of between-study heterogeneity were 0.389 and 0.502 for CSS and PFS analyses, respectively. As illustrated in [Figure 2], the combined HR of 1.91 (95% CI, 1.36-2.69) showed that the high CRP level had significant relationship with CSS in PCa patients. As for the ability to evaluate PFS, the pooled HR was 1.50 (95% CI, 1.25-1.81) for each unit increase in CRP.

From the above data, CRP proved to be a prognostic biomarker for OS, CSS and PFS in PCa. However, as an inflammatory marker, CRP was not significantly associated with OS, CSS and PFS when a risk cutoff of 2.0 was used. [27]

Publication bias

Finally, we applied funnel plots and Egger's test to evaluate publication bias of the studies included in this meta-analysis. As shown in [Figure 3], two of the funnel plots were symmetrical. There was no evidence for significant publication bias for OS (categorized) and PFS, since the P value for Egger's regression intercepts were > 0.05 (P = 0.379 and P = 0.568). However, in the analyses of CSS, significant publication bias existed, with a P value of 0.020.
Figure 3: Funnel plots of studies included in the three meta-analyses: ( a ) overall survival (OS), ( b ) cancer-specific survival (CSS) and ( c ) progression-free survival (PFS). HR: hazard ratio; S.E.: standard error.

Click here to view

  Discussion Top

In recent decades, a variety of predictors have been identified and applied for predicting PCa outcomes. We currently use prostate-specific antigen, prostate-specific membrane antigen and prostate stem cell antigen in routine pathological assessment of PCa. Many clinical studies have indicated that epithelial growth factor receptor, pAKT, nuclear factor-kappa B, macrophage inhibitory cytokine-1, matrix metalloproteinase-1 and matrix metalloproteinase-9 are associated with survival in PCa patients. [26],[27] In addition, microRNAs have become novel members of the predictive family with the development of molecular biology. For example, miQ, a novel microRNA has been shown to be closely associated with survival in PCa patients, [28] so as to microRNA 224. [29] However, the above-mentioned biomarkers should be examined in cancerous tissues. Thus, it is difficult to monitor their levels continuously in the process of disease progression. In contrast, the inflammation indicators can be easily assayed in plasma or serum, which is widely applied in a clinic set-up. In order to improve their prognostic accuracy, it is suggested that biomarkers should be carefully selected and integrated to develop a prognostic system. Recently, the Glasgow Prognostic Score has been developed to evaluate the value of an inflammation-based score in patients with metastatic PCa. The Glasgow Prognostic Score, evaluating elevated CRP (>10 mg l−1 ) and hypoalbuminemia (<35 g l−1 ), appears to be a useful indicator of worse outcome, independent of treatment in patients with metastatic PCa. [30]

There are a number of possible mechanisms by which CRP is associated with worse outcome in patients with cancer. Firstly, chronic inflammation can promote carcinogenesis, which can contribute to the onset or progression of cancer and circulating concentrations of vascular endothelial growth factor are directly associated with CRP. [31] Secondly, immune response can be invoked by rapid tumor growth, and thus many inflammatory factors are released. Inflammation can cause tumorigenesis by supplying the tumor microenvironment with bioactive molecules, including growth factors that induce proliferation, survival factors that reduce cell death, proangiogenic factors, extracellular matrix-modifying enzymes that stimulate angiogenesis, invasion and metastasis, inductive signals that facilitate epithelial-to-mesenchymal transition and other effects. [32] Previous studies have reported that other inflammatory markers such as serum interleukin (IL-6), soluble tumor necrosis factor receptor II and Epac1 as other PCa prognostic factors. [33],[34] An elevated CRP identifies those patients with an impaired T-lymphocytic response, since poor infiltration of tumor appears to be associated with poor outcome [35],[36] and an elevated CRP concentration has recently been shown to be inversely associated with T-lymphocyte subset infiltration. [37] Our meta-analysis has proven the prognostic value of CRP, which is a most commonly used and a representative inflammatory marker in PCa.

Our study showed that an elevated CRP level could predict poor survival in patients with PCa. Our data showed that CRP level was associated with OS, CSS and PFS. The pooled risks of CRP for OS, CSS and PFS, although, were statistically significant (P < 0.05), were not strong when an HR of more than two was considered as the cutoff for a strong predictor. [25]

However, the above conclusion should be tempered for several reasons. First, in the OS group, there was some heterogeneity of subjects for log CRP. Heterogeneity might be contributed by the baseline characteristics of the patients, such as age, differentiation or disease stage, adjuvant treatment they might have received, the duration of follow-up and adjustments for other cofactors. It is possible that the results of this meta-analysis could have been influenced by the heterogeneity. The treatment methods of the nine studies included in our study are different, and thus it can affect the positive associations between CRP and PCa prognosis. For example, in one study, those patients were treated with docetaxel and corticosteroid, [18] three studies used docetaxel-based chemotherapy, [12],[13],[23] three studies did not state the exact treatment method, [20],[22],[23] one study used androgen-deprived therapy [19] and in one study, the patients were divided into two groups in which one group of patients received radiation therapy after undergoing radical prostatectomy, while the other group patients were managed with definitive radiation therapy alone. [24] Taking into account that such differences might have a confounding effect with this study, we chose to apply a random model to minimize the effect. Since there were only two such studies, we did not assess the source of heterogeneity by sensitivity analyses. The CRP is usually regarded as a prognostic marker in several diseases which are related to survival, such as cardiovascular diseases. Thus, we cannot consider CRP as a 'predictor' for survival unless the involved patients do not have other severe diseases related to CRP. Because the presence or absence of concomitant severe diseases was not mentioned in the selected studies, we should be careful while considering CRP as a predictor of survival in cancer patients.

Meanwhile, there are other limitations in this study. The technique of detecting CRP may lack comparability among the studies. One study in the meta-analysis used immunohistochemistry staining to study expressions of CRP. Although immunohistochemistry staining is simple and cost-effective to perform, results are highly dependent on a variety of methodological factors. Finally, only eligible studies were included in the meta-analysis, which could explain the obvious publication bias for CSS. Thus, we need further studies with larger sample sizes to confirm the positive associations.

Our meta-analysis also had some advantages. First, the quality of studies included in the meta-analysis was satisfactory and strictly met the inclusion criteria. Second, all the extrapolated HRs were directly obtained from published statistics, and this method is more reliable than the calculated values from the data included in the article or extrapolated from the survival curves. Third, there were no significant heterogeneity for OS (categorized CRP), CSS and PFS. Fourth, we adopted Begg's funnel plot and Egger's test to assess the publication bias and the results failed to show any obvious evidence of publication bias either for OS or PFS.

  Conclusions Top

In conclusion, our meta-analysis, including a quantified synthesis of all published studies, indicated that elevated CRP expression is significantly associated with worse PCa survival, and CRP is a strong predictor for all three survival outcomes, especially for CSS. The critical role of CRP in cancer prognosis may contribute to its clinical utility. Considering the limitations of the present meta-analysis, further research with standardized unbiased methods and larger, worldwide sample sizes are expected to confirm our results.

  Author Contributions Top

ZQL, LC and QX conceived and designed the study. JMF and XZ collected the data. HXZ and YJC performed the statistical analyses. ZQL and LC drafted and revised the manuscript. All authors read and approved the final manuscript.

  Competing Interests Top

All authors declare no competing interests.

  Acknowledgments Top

This study is supported by the National Natural Science Foundation of China (No.: 30872591) and Shanghai Science and Technology Commission (No.: 11411950602).

  References Top

1.Jemal A, Bray F, Center MM, Ferlay J, Ward E, et al. Global cancer statistics. CA Cancer J Clin 2011; 61: 69-90.  Back to cited text no. 1
2.Halabi S, Vogelzang NJ, Kornblith AB, Ou SS, Kantoff PW, et al. Pain predicts overall survival in men with metastatic castration-refractory prostate cancer. J Clin Oncol 2008; 26: 2544-9.  Back to cited text no. 2
3.Halabi S, Small EJ, Kantoff PW, Kattan MW, Kaplan EB, et al. Prognostic model for predicting survival in men with hormone-refractory metastatic prostate cancer. J Clin Oncol 2003; 21: 1232-7.  Back to cited text no. 3
4.Smaletz O, Scher HI, Small EJ, Verbel DA, McMillan A, et al. Nomogram for overall survival of patients with progressive metastatic prostate cancer after castration. J Clin Oncol 2002; 20: 3972-82.  Back to cited text no. 4
5.Armstrong AJ, Garrett-Mayer ES, Yang YC, de Wit R, Tannock IF, et al. A contemporary prognostic nomogram for men with hormone-refractory metastatic prostate cancer: a TAX327 study analysis. Clin Cancer Res 2007; 13: 6396-403.  Back to cited text no. 5
6.Armstrong AJ, Tannock IF, de Wit R, George DJ, Eisenberger M, et al. The development of risk groups in men with metastatic castration-resistant prostate cancer based on risk factors for PSA decline and survival. Eur J Cancer 2010; 46: 517-25.  Back to cited text no. 6
7.Armstrong AJ, Garrett-Mayer E, de Wit R, Tannock I, Eisenberger M. Prediction of survival following first-line chemotherapy in men with castration-resistant metastatic prostate cancer. Clin Cancer Res 2010; 16: 203-11.  Back to cited text no. 7
8.Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol 2010; 6: 149-63.  Back to cited text no. 8
9.Wu Y, Fu X, Zhu X, He X, Zou C, et al. Prognostic role of systemic inflammatory response in renal cell carcinoma: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2011; 137: 887-96.  Back to cited text no. 9
10.Hurlimann J, Thorbecke G J, Hochwald GM. The liver as the site of C-reactive protein formation. J Exp Med 1966; 123: 365-78.  Back to cited text no. 10
11.Tillett WS, Francis Jr T. Serological reactions in pneumonia with a non-protein fraction of pneumococcus. J Exp Med 1930; 52: 561-71.  Back to cited text no. 11
12.Beer TM, Lalani AS, Lee S, Mori M, Eilers KM, et al. C-reactive protein as a prognostic marker for men with androgen-independent prostate cancer: results from the ASCENT trial. Cancer 2008; 112: 2377-83.  Back to cited text no. 12
13.Prins RC, Rademacher BL, Mongoue-Tchokote S, Alumkal JJ, Graff JN, et al. C-reactive protein as an adverse prognostic marker for men with castration- resistant prostate cancer (CRPCa): confirmatory results. Urol Oncol 2012; 30: 33-7.  Back to cited text no. 13
14.Elsberger B, Lankston L, McMillan DC, Underwood MA, Edwards J. Presence of tumoural C-reactive protein correlates with progressive prostate cancer. Prostate Cancer Prostatic Dis 2011; 14:122-8.  Back to cited text no. 14
15.Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283: 2008-12.  Back to cited text no. 15
16.Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 1998; 17: 2815-34.  Back to cited text no. 16
17.Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-34.  Back to cited text no. 17
18.Ito M, Saito K, Yasuda Y, Sukegawa G, Kubo Y, et al. Prognostic impact of C-reactive protein for determining overall survival of patients with castration-resistant prostate cancer treated with docetaxel. Urology 2011; 78: 1131-5.  Back to cited text no. 18
19.McArdle PA, Mir K, Almushatat AS, Wallace AM, Underwood MA, et al. Systemic inflammatory response, prostate-specific antigen and survival in patients with metastatic prostate cancer. Urol Int 2006; 77: 127-9.  Back to cited text no. 19
20.Stark JR, Li H, Kraft P, Kurth T, Giovannucci EL, et al. Circulating prediagnostic interleukin-6 and C-reactive protein and prostate cancer incidence and mortality. Int J Cancer 2009; 124: 2683−9.  Back to cited text no. 20
21.McArdle PA, Qayyum T, McMillan DC. Systemic inflammatory response and survival in patients with localised prostate cancer: 10-year follow-up. Urol Int 2010; 85: 482.  Back to cited text no. 21
22.McCall P, Catlow J, McArdle PA, McMillan DC, Edwards J. Tumoral C-reactive protein and nuclear factor kappa-B expression are associated with clinical outcome in patients with prostate cancer. Cancer Biomark 2011-2012; 10: 91-9.  Back to cited text no. 22
23.Pond GR, Armstrong AJ, Wood BA, Leopold L, Galsky MD, et al. Ability of C-reactive protein to complement multiple prognostic classifiers in men with metastatic castration resistant prostate cancer receiving docetaxel-based chemotherapy. BJU Int 2012; 110: E461-8.  Back to cited text no. 23
24.Hall WA, Nickleach DC, Master VA, Prabhu RS, Rossi PJ, et al. The association between C-reactive protein (CRP) level and biochemical failure-free survival in patients after radiation therapy for nonmetastatic adenocarcinoma of the prostate. Cancer 2013; 119: 3272-9.  Back to cited text no. 24
25.Hayes DF, Isaacs C, Stearns V. Prognostic factors in breast cancer: current and new predictors of metastasis. J Mammary Gland Biol Neoplasia 2001; 6: 375-92.  Back to cited text no. 25
26.Mimeault M, Johansson SL, Batra SK. Pathobiological implications of the expression of EGFR, pAkt, NF-kB and MIC-1 in prostate cancer stem cells and their progenies. PLoS ONE 2012; 7: e31919.  Back to cited text no. 26
27.Ozden F, Saygin C, Uzunaslan D, Onal B, Durak H, et al. Expression of MMP-1, MMP-9 and TIMP-2 in prostate carcinoma and their influence on prognosis and survival. J Cancer Res Clin Oncol 2013; 139: 1373-82.  Back to cited text no. 27
28.Larne O, Martens-Uzunova E, Hagman Z, Edsjö A, Lippolis G, et al. miQ-a novel microRNA based diagnostic and prognostic tool for prostate cancer. Int J Cancer 2013; 132: 2867-75.  Back to cited text no. 28
29.Mavridis K, Stravodimos K, Scorilas A. Downregulation and prognostic performance of microRNA 224 expression in prostate cancer. Clin Chem 2013; 59: 261-9.  Back to cited text no. 29
30.Shafique K, Proctor MJ, McMillan DC, Qureshi K, Leung H, et al. Systemic inflammation and survival of patients with prostate cancer: evidence from the Glasgow Inflammation Outcome Study. Prostate Cancer Prostatic Dis 2012; 15: 195-201.  Back to cited text no. 30
31.Xavier P, Belo L, Beires J, Rebelo I, Martinez-de-Oliveira J, et al. Serum levels of VEGF and TNF-alpha and their association with C-reactive protein in patients with endometriosis. Arch Gynecol Obstet 2006; 273: 227-31.  Back to cited text no. 31
32.Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell 2011; 144: 646-74.  Back to cited text no. 32
33.Misra UK, Pizzo SV. Evidence for a pro-proliferative feedback loop in prostate cancer: the role of Epac1 and COX-2-dependent pathways. PLoS One 2013; 8: e63150.  Back to cited text no. 33
34.Hoyt MA, Stanton AL, Bower JE, Thomas KS, Litwin MS, et al. Inflammatory biomarkers and emotional approach coping in men with prostate cancer. Brain Behav Immun 2013; 32:173-9.  Back to cited text no. 34
35.Jass JR, Love SB, Northover JM. A new prognostic classification of rectal cancer. Lancet 1987; 1: 1303-6.  Back to cited text no. 35
36.Nielsen HJ, Hansen U, Christensen IJ, Reimert CM, Brunner N, et al. The RANX05 Study Group Independent prognostic value of eosinophil and mastcell infiltration in colorectal cancer tissue. J Pathol 1999; 189: 487-95.  Back to cited text no. 36
37.Canna K, McArdle PA, McMillan DC, McNicol AM, Smith GW, et al. The relationship between tumour T-lymphocyte infiltration, the systemic inflammatory response and survival in patients undergoing curative resection for colorectal cancer. Br J Cancer 2005; 92: 651-4.  Back to cited text no. 37


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1]

This article has been cited by
1 Advances in Multiplexed Paper-Based Analytical Devices for Cancer Diagnosis: A Review of Technological Developments
Nihan Yonet-Tanyeri,Benjamin Z. Ahlmark,Steven R. Little
Advanced Materials Technologies. 2021; : 2001138
[Pubmed] | [DOI]
2 Combined Longitudinal Clinical and Autopsy Phenomic Assessment in Lethal Metastatic Prostate Cancer: Recommendations for Advancing Precision Medicine
Juho Jasu,Teemu Tolonen,Emmanuel S. Antonarakis,Himisha Beltran,Susan Halabi,Mario A. Eisenberger,Michael A. Carducci,Yohann Loriot,Kim Van der Eecken,Martijn Lolkema,Charles J. Ryan,Sinja Taavitsainen,Silke Gillessen,Gunilla Högnäs,Timo Talvitie,Robert J. Taylor,Antti Koskenalho,Piet Ost,Teemu J. Murtola,Irina Rinta-Kiikka,Teuvo Tammela,Anssi Auvinen,Paula Kujala,Thomas J. Smith,Pirkko-Liisa Kellokumpu-Lehtinen,William B. Isaacs,Matti Nykter,Juha Kesseli,G. Steven Bova
European Urology Open Science. 2021; 30: 47
[Pubmed] | [DOI]
3 Biomarkers for Malignant Pleural Mesothelioma—A Novel View on Inflammation
Melanie Vogl,Anna Rosenmayr,Tomas Bohanes,Axel Scheed,Milos Brndiar,Elisabeth Stubenberger,Bahil Ghanim
Cancers. 2021; 13(4): 658
[Pubmed] | [DOI]
4 Combined C-Reactive Protein and Novel Inflammatory Parameters as a Predictor in Cancer—What Can We Learn from the Hematological Experience?
Øystein Bruserud,Helene Hersvik Aarstad,Tor Henrik Anderson Tvedt
Cancers. 2020; 12(7): 1966
[Pubmed] | [DOI]
5 Global assessment of C-reactive protein and health-related outcomes: an umbrella review of evidence from observational studies and Mendelian randomization studies
Georgios Markozannes,Charalampia Koutsioumpa,Sofia Cividini,Grace Monori,Konstantinos K. Tsilidis,Nikolaos Kretsavos,Evropi Theodoratou,Dipender Gill,John PA Ioannidis,Ioanna Tzoulaki
European Journal of Epidemiology. 2020;
[Pubmed] | [DOI]
6 C-Reactive Protein and Cancer—Diagnostic and Therapeutic Insights
Peter C. Hart,Ibraheem M. Rajab,May Alebraheem,Lawrence A. Potempa
Frontiers in Immunology. 2020; 11
[Pubmed] | [DOI]
7 Statin use and risk of prostate cancer biochemical recurrence after radical prostatectomy
Nicole Prabhu,Navina Kapur,William Catalona,Robin Leikin,Irene Helenowski,Borko Jovanovich,Michael Gurley,Tochi M. Okwuosa,Timothy M. Kuzel
Urologic Oncology: Seminars and Original Investigations. 2020;
[Pubmed] | [DOI]
8 The Basic Characteristics of the Pentraxin Family and Their Functions in Tumor Progression
Zeyu Wang,Xing Wang,Hecun Zou,Ziyu Dai,Songshan Feng,Mingyu Zhang,Gelei Xiao,Zhixiong Liu,Quan Cheng
Frontiers in Immunology. 2020; 11
[Pubmed] | [DOI]
9 Prognostic impact of C-reactive protein-albumin ratio for the lethality in castration-resistant prostate cancer
Taizo Uchimoto,Kazumasa Komura,Yuya Fujiwara,Kenkichi Saito,Naoki Tanda,Tomohisa Matsunaga,Atsushi Ichihashi,Takeshi Tsutsumi,Takuya Tsujino,Yuki Yoshikawa,Yudai Nishimoto,Tomoaki Takai,Koichiro Minami,Kohei Taniguchi,Tomohito Tanaka,Hirofumi Uehara,Hajime Hirano,Hayahito Nomi,Naokazu Ibuki,Kiyoshi Takahara,Teruo Inamoto,Haruhito Azuma
Medical Oncology. 2020; 37(1)
[Pubmed] | [DOI]
10 Profiling of metabolic biomarkers in the serum of prostate cancer patients
F. Ali,S. Akram,S. Niaz,N. Wajid
The Ukrainian Biochemical Journal. 2020; 92(1): 56
[Pubmed] | [DOI]
11 Prognostic impact of interleukin-6 and C-reactive protein on patients with breast cancer
Tatsuo Shimura,Masahiko Shibata,Kenji Gonda,Yuko Murakami,Masaru Noda,Kazunoshin Tachibana,Noriko Abe,Tohru Ohtake
Oncology Letters. 2019;
[Pubmed] | [DOI]
12 Dietary inflammatory index is associated with increased risk of prostate cancer among Vietnamese men
Dong Van Hoang,Nitin Shivappa,Ngoc Minh Pham,James R. Hebert,Colin W. Binns,Andy H. Lee
Nutrition. 2019;
[Pubmed] | [DOI]
13 MRI-guided, transrectal, intraprostatic steam application as potential focal therapeutic modality for prostatic diseases in a large animal translational model: A feasibility follow-up study
Adriano Wang-Leandro,Florian Willmitzer,Agnieszka Karol,Beat Porcellini,Peter Kronen,Emile M. Hiltbrand,Daniel Rüfenacht,Patrick R. Kircher,Henning Richter,Haydar Celik
PLOS ONE. 2019; 14(12): e0226764
[Pubmed] | [DOI]
14 Prognostic impact of elevated preoperative C-reactive protein on patients with differentiated thyroid carcinoma
Tatsuo Shimura,Masahiko Shibata,Kenji Gonda,Yoshiko Matsumoto,Keiichi Nakano,Manabu Iwadate,Satoshi Suzuki,Shinichi Suzuki
Journal of Surgical Research. 2018; 231: 338
[Pubmed] | [DOI]
15 Serum inflammatory markers in relation to prostate cancer severity and death in the Swedish AMORIS study
R. Arthur,R. Williams,H. Garmo,L. Holmberg,P. Stattin,H. Malmström,M. Lambe,N. Hammar,G. Walldius,D. Robinsson,I. Jungner,M. Van Hemelrijck
International Journal of Cancer. 2018;
[Pubmed] | [DOI]
16 Clinical utility of the modified Glasgow prognostic score in lung cancer: A meta-analysis
Jing Jin,Kejia Hu,Yongzhao Zhou,Weimin Li,Shian-Ying Sung
PLOS ONE. 2017; 12(9): e0184412
[Pubmed] | [DOI]
17 Serum monocyte fraction of white blood cells is increased in patients with high Gleason score prostate cancer
Takuji Hayashi,Kazutoshi Fujita,Go Tanigawa,Atsunari Kawashima,Akira Nagahara,Takeshi Ujike,Motohide Uemura,Tetsuya Takao,Seiji Yamaguchi,Norio Nonomura
Oncotarget. 2017; 8(21): 35255
[Pubmed] | [DOI]
18 Association of ANRIL gene polymorphisms with prostate cancer and benign prostatic hyperplasia in an Iranian population
Mohammad Taheri,Farkhondeh Pouresmaeili,Mir Davood Omrani,Mohsen Habibi,Shaghayegh Sarrafzadeh,Rezvan Noroozi,Azadeh Rakhshan,Arezou Sayad,Soudeh Ghafouri-Fard
Biomarkers in Medicine. 2017; 11(5): 413
[Pubmed] | [DOI]
19 Aspirin Use Reduces the Risk of Aggressive Prostate Cancer and Disease Recurrence in African-American Men
Cheryl Jacobs Smith,Tiffany H. Dorsey,Wei Tang,Symone V. Jordan,Christopher A. Loffredo,Stefan Ambs
Cancer Epidemiology Biomarkers & Prevention. 2017; 26(6): 845
[Pubmed] | [DOI]
20 The impact of elevated C-reactive protein level on the prognosis for oro-hypopharynx cancer patients treated with radiotherapy
Atsuto Katano,Wataru Takahashi,Hideomi Yamashita,Kentaro Yamamoto,Mizuo Ando,Masafumi Yoshida,Yuki Saito,Osamu Abe,Keiichi Nakagawa
Scientific Reports. 2017; 7(1)
[Pubmed] | [DOI]
21 Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Prostate Cancer
Xiaotao Yin,Yi Xiao,Fanglong Li,Siyong Qi,Zhaoyang Yin,Jiangping Gao
Medicine. 2016; 95(3): e2544
[Pubmed] | [DOI]
22 Systemic Inflammatory Response Based on Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker in Bladder Cancer
Hyung Suk Kim,Ja Hyeon Ku
Disease Markers. 2016; 2016: 1
[Pubmed] | [DOI]
23 Association between the inflammatory biomarker, C-reactive protein, and the response to radiochemotherapy in patients with esophageal cancer
Molecular and Clinical Oncology. 2016; 4(4): 643
[Pubmed] | [DOI]
24 Intrahepatic cholangiocarcinoma prognostic determination using pre-operative serum C-reactive protein levels
Zi-Ying Lin,Zhen-Xing Liang,Pei-Lin Zhuang,Jie-Wei Chen,Yun Cao,Li-Xu Yan,Jing-Ping Yun,Dan Xie,Mu-Yan Cai
BMC Cancer. 2016; 16(1)
[Pubmed] | [DOI]
25 Early post-operative acute phase response in patients with early graft dysfunction is predictive of 6-month and 12-month mortality in liver transplant recipients
Hani Oweira,Imad Lahdou,Volker Daniel,Gerhard Opelz,Jan Schmidt,Ahmed Zidan,Arianeb Mehrabi,Mahmoud Sadeghi
Human Immunology. 2016;
[Pubmed] | [DOI]
26 Pretreatment C-reactive protein was an independent prognostic factor for patients with diffuse large B-cell lymphoma treated with RCHOP
Jing Wang,Min Zhou,Xiaoyue Wang,Jingyan Xu,Bing Chen,Jian Ouyang
Clinica Chimica Acta. 2016; 459: 150
[Pubmed] | [DOI]
27 The elevated C-reactive protein level is associated with poor prognosis in prostate cancer patients treated with radiotherapy
Eva-Maria Thurner,Sabine Krenn-Pilko,Uwe Langsenlehner,Tatjana Stojakovic,Martin Pichler,Armin Gerger,Karin S. Kapp,Tanja Langsenlehner
European Journal of Cancer. 2015;
[Pubmed] | [DOI]
28 Pooled analysis of C-Reactive Protein levels and mortality in prostate cancer patients
Julie N. Graff,Tomasz M. Beer,Bian Liu,Guru Sonpavde,Emanuela Taioli
Clinical Genitourinary Cancer. 2015;
[Pubmed] | [DOI]
29 Prognostic significance of neutrophil to lymphocyte ratio in pancreatic cancer: A meta-analysis
Jian-Jun Yang
World Journal of Gastroenterology. 2015; 21(9): 2807
[Pubmed] | [DOI]
30 Elevated High-Sensitivity C-Reactive Protein Levels Predict Decreased Survival for Nasopharyngeal Carcinoma Patients in the Intensity-Modulated Radiotherapy Era
Lin Quan Tang,Dong Peng Hu,Qiu Yan Chen,Lu Zhang,Xiao Ping Lai,Yun He,Yun-Xiu-Xiu Xu,Shi-Hua Wen,Yu-Tuan Peng,Wen-Hui Chen,Shan-Shan Guo,Li-Ting Liu,Chao-Nan Qian,Xiang Guo,Mu-Sheng Zeng,Hai-Qiang Mai,Eng-Huat Tan
PLOS ONE. 2015; 10(4): e0122965
[Pubmed] | [DOI]
31 C-reactive protein in urologic cancers
Jonathan Huang,Yoram Baum,Mehrdad Alemozaffar,Kenneth Ogan,Wayne Harris,Omer Kucuk,Viraj A. Master
Molecular Aspects of Medicine. 2015; 45: 28
[Pubmed] | [DOI]
32 Preoperative C-reactive protein as a prognostic predictor for upper tract urothelial carcinoma: A systematic review and meta-analysis
You Luo,Sheng Fu,Dong She,Hu Xiong,Li Yang
Molecular and Clinical Oncology. 2015;
[Pubmed] | [DOI]
33 Procalcitonin as a biomarker for infection-related mortality in cancer patients
Ali M. Sedef,Fatih Kose,Huseyin Mertsoylu,Ozgur Ozyilkan
Current Opinion in Supportive & Palliative Care. 2015; 9(2): 168
[Pubmed] | [DOI]
34 Association between preoperative C-reactive protein level and colorectal cancer survival: a meta-analysis
Hae Dong Woo,Kyeezu Kim,Jeongseon Kim
Cancer Causes & Control. 2015; 26(11): 1661
[Pubmed] | [DOI]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Materials and Me...
Author Contributions
Competing Interests
Article Figures
Article Tables

 Article Access Statistics
    PDF Downloaded589    
    Comments [Add]    
    Cited by others 34    

Recommend this journal