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
. 2022 Nov 29;14(23):5898.
doi: 10.3390/cancers14235898.

C-Reactive Protein Pretreatment-Level Evaluation for Ewing's Sarcoma Prognosis Assessment-A 15-Year Retrospective Single-Centre Study

Sarah Consalvo  1 , Florian Hinterwimmer  2 , Norbert Harrasser  1 , Ulrich Lenze  1 , Georg Matziolis  3 , Rüdiger von Eisenhart-Rothe  1 , Carolin Knebel  1
Affiliations

C-Reactive Protein Pretreatment-Level Evaluation for Ewing's Sarcoma Prognosis Assessment-A 15-Year Retrospective Single-Centre Study

Sarah Consalvo et al. Cancers (Basel). .

Abstract

Background: A pathological/inflamed cellular microenvironment state is an additional risk factor for any cancer type. The importance of a chronic inflammation state in most diffuse types of tumour has already been analysed, except for in Ewing’s sarcoma. It is a highly malignant blue round cell tumour, with 90% of cases occurring in patients aged between 5 and 25 years. Worldwide, 2.9 out of 1,000,000 children per year are affected by this malignancy. The aim of this retrospective study was to analyse the role of C-reactive protein (CRP) as a prognostic factor for Ewing’s sarcomas. Methods: This retrospective study at Klinikum rechts der Isar included 82 patients with a confirmed Ewing’s sarcoma diagnosis treated between 2004 and 2019. Preoperative CRP determination was assessed in mg/dL with a normal value established as below 0.5 mg/dL. Disease-free survival time was calculated as the time between the initial diagnosis and an event such as local recurrence or metastasis. Follow-up status was described as death of disease (DOD), no evidence of disease (NED) or alive with disease (AWD). The exclusion criteria of this study included insufficient laboratory values and a lack of information regarding the follow-up status or non-oncological resection. Results: Serum CRP levels were significantly different in patients with a poorer prognosis (DOD) and in patients who presented distant metastasis (p = 0.0016 and p = 0.009, respectively), whereas CRP levels were not significantly different in patients with local recurrence (p = 0.02). The optimal breakpoint that predicted prognosis was 0.5 mg/dL, with a sensitivity of 0.76 and a specificity of 0.74 (AUC 0.81). Univariate CRP analysis level >0.5 mg/dL revealed a hazard ratio of 9.5 (95% CI 3.5−25.5). Conclusions: In Ewing’s sarcoma cases, we consider a CRP pretreatment value >0.5 mg/dL as a sensitive prognostic risk factor indication for distant metastasis and poor prognosis. Further research with more data is required to determine more sensitive cutoff levels.

Keywords: CRP; Ewing’s sarcoma; local recurrence; metastasis; prognosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Box plot of the median CRP values (red line) depending on the follow-up status of the patients: no evidence of disease (NED) and death of disease (DOD). For the alive with disease (AWD) status, no diagram was created because only two patients were involved. ×: extreme outliners, ●: mild outliners.
Figure 2
Figure 2
Kaplan-Meier curve of the survival rate depending on the CRP value: red corresponds to the group with an increased CRP value and blue corresponds to the group with a lower CRP value. The follow-up time is evaluated in years (p-value: 0.005).
Figure 3
Figure 3
Kaplan-Meier curve of the recurrence/remote metastasis-free time as a function of the CRP value: red corresponds to the group with an increased CRP value andblue corresponds to the group with a lower CRP value. The DFS time is evaluated in years (p-value: 0.006).
Figure 4
Figure 4
ROC Curve (AUC = 0.812). Optimal breakpoint analysis of CRP as a prognostic factor of OS.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Picci P., Manfrini M., Fabbri N., Gambarotti M., Vanel D. Atlas of Musculoskeletal Tumors and Tumorlike Lesions: The Rizzoli Case Archive. Springer International Publishing; Cham, Switzerland: 2016.
    1. Ahmed S.K., Witten B.G., Harmsen W.S., Rose P.S., Krailo M., Marcus K.J., Randall R.L., DuBois S.G., Janeway K.A., Womer R.B., et al. Analysis of local control outcomes and clinical prognostic factors in localized pelvic Ewing sarcoma patients treated with radiation therapy: A Report from the Children’s Oncology Group. Int. J. Radiat. Oncol. Biol. Phys. 2022 doi: 10.1016/j.ijrobp.2022.07.1840. - DOI - PMC - PubMed
    1. Indelicato D.J., Vega R.B.M., Viviers E., Morris C.G., Bradfield S.M., Gibbs C.P., Bradley J.A. Modern Therapy for Chest Wall Ewing Sarcoma: An Update of the University of Florida Experience. Int. J. Radiat. Oncol. Biol. Phys. 2022;113:345–354. doi: 10.1016/j.ijrobp.2022.02.011. - DOI - PubMed
    1. Indelicato D.J., Vega R.B.M., Viviers E., Morris C.G., Bradfield S.M., Ranalli N.J., Bradley J.A. Modern Therapy for Spinal and Paraspinal Ewing Sarcoma: An Update of the University of Florida Experience. Int. J. Radiat. Oncol. Biol. Phys. 2022;113:161–165. doi: 10.1016/j.ijrobp.2022.01.007. - DOI - PubMed
    1. Durer S., Shaikh H. StatPearls. StatPearls Publishing; Treasure Island, FL, USA: 2022. Ewing Sarcoma. - PubMed