Annals of Surgical Oncology, Vol 7, Issue 8 617-623, Copyright © 2000 by Society of Surgical Oncology

ARTICLES

Preoperative plasma plasminogen activator inhibitor type-1 and serum C-reactive protein levels in patients with colorectal cancer. The RANX05 Colorectal Cancer Study Group

H. J. Nielsen, I. J. Christensen, S. Sorensen, F. Moesgaard and N. Brunner
Department of Surgical Gastroenterology, Hvidovre University Hospital, Denmark. h.j.nielsen@forum.dk

BACKGROUND: Preoperative plasma plasminogen activator inhibitor-1 (PAI-1) is a prognostic variable in patients with colorectal cancer. It has been suggested, however, that plasma PAI-1 is a nonspecific prognostic parameter similar to the acute-phase reactant C-reactive protein (CRP). In the present study we analyzed the association between plasma PAI-1 and serum CRP in patients scheduled for elective resection of colorectal cancer. In addition, the prognostic value of PAI-1 and CRP was studied in this patient cohort. METHODS: PAI-1 and CRP were analyzed in citrated plasma and serum, respectively, obtained preoperatively from 594 patients. Patients who required preoperative blood transfusion received SAGM blood, in which soluble PAI-1 is not present. None of the patients received pre- or postoperative adjuvant chemotherapy, and all were followed in the outpatient clinic for at least 5 years or until death. The association of PAI-1 and CRP, respectively, with survival was tested using the median value of PAI-1 and the upper normal limit for CRP. Analyses were performed by inclusion of all patients, and in the subgroup of patients, who underwent curative resection. RESULTS: The median follow-up period was 6.8 (5.4-7.9) years. The median value of plasma PAI-1 was 35.8 ng/ml, and values greater than 94 nmol/L identified patients with increased CRP levels. Comparison of the molecules showed that PAI-1 was weakly correlated with CRP (r = .26; P <.0001). Both molecules showed a Dukes independent distribution. In univariate survival analyses high levels of PAI-1 were found associated with poor prognosis and low levels with good prognosis (P = .02, HR: 1.3). Similarly, high levels of CRP were found associated with poor prognosis and low levels with good prognosis (P <.0001, HR: 1.9). In a multivariate statistical analysis including Dukes classification, gender, age, tumor location, perioperative blood transfusion, PAI-1 and CRP, plasma PAI-1 was a dependent prognostic variable, while serum CRP (P <.0001; HR: 1.4; 95% CI: 1.3-1.5) was found to be a Dukes independent prognostic variable. Similar analyses, excluding patients with Dukes' D disease showed serum CRP to be an independent prognostic variable (P <.0001; HR: 1.3: 95% CI: 1.2-1.5). CONCLUSIONS: This study did not show a strong correlation between plasma PAI-1 and serum CRP in patients with colorectal cancer. Serum CRP was found to be a Dukes independent prognostic variable in this patient cohort, and was found to identify a subgroup of curatively resected patients at risk for short survival.

This article has been cited by other articles:

				M. Schmid, A. Schneitter, S. Hinterberger, J. Seeber, A. Reinthaller, and L. Hefler Association of Elevated C-reactive Protein Levels With an Impaired Prognosis in Patients With Surgically Treated Endometrial Cancer Obstet. Gynecol., December 1, 2007; 110(6): 1231 - 1236. [Abstract] [Full Text] [PDF]

				D. Lithgow, A. Nyamathi, D. Elashoff, O. Martinez-Maza, and C. Covington C-reactive Protein in Nipple Aspirate Fluid Associated With Gail Model Factors Biol Res Nurs, October 1, 2007; 9(2): 108 - 116. [Abstract] [PDF]

				K. H. Minor, C. R. Schar, G. E. Blouse, J. D. Shore, D. A. Lawrence, P. Schuck, and C. B. Peterson A Mechanism for Assembly of Complexes of Vitronectin and Plasminogen Activator Inhibitor-1 from Sedimentation Velocity Analysis J. Biol. Chem., August 5, 2005; 280(31): 28711 - 28720. [Abstract] [Full Text] [PDF]

				S. M. Zhang, J. E. Buring, I-M. Lee, N. R. Cook, and P. M. Ridker C-Reactive Protein Levels Are Not Associated with Increased Risk for Colorectal Cancer in Women Ann Intern Med, March 15, 2005; 142(6): 425 - 432. [Abstract] [Full Text] [PDF]

				J. M. Wallace Nutritional and Botanical Modulation of the Inflammatory Cascade--Eicosanoids, Cyclooxygenases, and Lipoxygenases-- As an Adjunct in Cancer Therapy Integr Cancer Ther, March 1, 2002; 1(1): 7 - 37. [Abstract] [PDF]