Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jul 18;8(29):47090-47102.
doi: 10.18632/oncotarget.17478.

Elevated CRP levels predict poor outcome and tumor recurrence in patients with thymic epithelial tumors: A pro- and retrospective analysis

Stefan Janik  1   2 , Christine Bekos  1   2 , Philipp Hacker  1   2 , Thomas Raunegger  1   2 , Bahil Ghanim  1 , Elisa Einwallner  3 , Lucian Beer  2   4 , Walter Klepetko  1 , Leonhard Müllauer  5 , Hendrik J Ankersmit  1   2 , Bernhard Moser  1
Affiliations

Elevated CRP levels predict poor outcome and tumor recurrence in patients with thymic epithelial tumors: A pro- and retrospective analysis

Stefan Janik et al. Oncotarget. .

Abstract

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.

Keywords: CRP; prognosis; thymic carcinoma; thymic epithelial tumors; thymoma.

PubMed Disclaimer

Conflict of interest statement

CONFLICTS OF INTEREST

The authors declare no conflicts of interest

Figures

Figure 1
Figure 1. CRP serum concentrations in TETs
CRP serum concentrations were significantly elevated in patients with TETs (n = 128) compared to controls (n = 64) (A). Separate analysis of thymomas (n = 93), TCs (n = 30) and TNETs (n = 5) compared to controls are shown (B). Highest CRP concentrations were found in metastatic TETs (Masaoka-Koga Stage IV; (C). In patients with high pretreatment CRP (≥ 0.22 mg/dL), CRP levels decreased after complete tumor resection (n = 52) (D), but increased significantly in case of tumor recurrence (n = 16) (E). IL-6 serum concentrations are significantly elevated in TETs (n = 39) compared to controls (F).
Figure 2
Figure 2. Prognostic impact of CRP in TETs
Median CRP (0.22 mg/dL) was used for grouping patients into low and high CRP cohorts. Overall Survival, Cause Specific Survival and Freedom From Recurrence are shown (A–C). Log-rank test was performed for analyses.
Figure 3
Figure 3. CRP expression in TETs
CRP staining was absent in all TETs. Positive staining was only found in physiologic liver specimens (A; 200× magnification), which were used as positive control. Staining of WHO type AB thymoma (B), type B2 thymoma (C) and TC (D) are shown (all 200× magnification). TETs, thymic epithelial tumors; TC, thymic carcinoma.
See this image and copyright information in PMC

References

    1. Marx A, Chan JK, Coindre JM, Detterbeck F, Girard N, Harris NL, Jaffe ES, Kurrer MO, Marom EM, Moreira AL, Mukai K, Orazi A, Ströbel P. The 2015 World Health Organization Classification of Tumors of the Thymus: Continuity and Changes. J Thorac Oncol. 2015;10:1383–95. - PMC - PubMed
    1. Detterbeck FC, Nicholson AG, Kondo K, Van Schil P, Moran C. The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol. 2011;6:1710–1716. - PubMed
    1. Kondo K, Yoshizawa K, Tsuyuguchi M, Kimura S, Sumitomo M, Morita J, Miyoshi T, Sakiyama S, Mukai K, Monden Y. WHO histologic classification is a prognostic indicator in thymoma. Ann Thorac Surg. 2004;77:1183–1188. - PubMed
    1. Ströbel P, Bauer A, Puppe B, Kraushaar T, Krein A, Toyka K, Gold R, Semik M, Kiefer R, Nix W, Schalke B, Müller-Hermelink HK, Marx A. Tumor recurrence and survival in patients treated for thymomas and thymic squamous cell carcinomas: a retrospective analysis. J Clin Oncol. 2004;22:1501–1509. - PubMed
    1. Moser B, Scharitzer M, Hacker S, Ankersmit J, Matilla JR, Lang G, Aigner C, Taghavi S, Klepetko W. Thymomas and thymic carcinomas: prognostic factors and multimodal management. Thorac Cardiovasc Surg. 2014;62:153–160. - PubMed

MeSH terms

Supplementary concepts