C‑reactive protein and related predictors in soft tissue sarcoma (Review)

Abstract

C-reactive protein (CRP) is a useful predictor of poor survival in patients with several types of cancer because inflammation is strongly associated with cancer progression. The production of CRP in hepatocytes appears to be primarily induced at the transcriptional level following the elevation of circulating interleukin-6 (IL-6), which is produced by various cell types, including cancer cells and cancer-associated fibroblasts. Serum CRP levels are associated with serum IL-6 levels in patients with soft tissue sarcoma (STS). Additionally, patients with elevated CRP levels had worse oncological outcomes than those with normal CRP levels. It has been attempted to combine CRP levels with other inflammatory or immune markers, and the utility of this has been demonstrated. Therefore, a novel treatment strategy should be developed for patients with STS with elevated CRP levels. The present review aimed to clarify the role of CRP levels and related tools in predicting clinical outcomes in patients with STS.

Keywords: C-reactive protein; biomarker; inflammation; soft tissue sarcoma.

Figure 1

Inflammatory cytokine IL-6 contributes to the development of hypoalbuminemia and elevated CRP levels. Neutrophils release mediators to provide a stimulating microenvironment that allows for more aggressive tumor behavior around the tumor. Conversely, the absolute lymphocyte count is decreased in tumor-induced inflammation. CRP, C-reactive protein; IL-6, interleukin-6.

Figure 2

Process of evaluation and biopsy in STS. If elevated CRP levels (above standard levels of CRP) are observed in addition to clinical characteristics such as tumor size and depth, and MRI findings, biopsy should be considered to identify STS. CRP, C-reactive protein; STS, soft tissue sarcoma; T1WI, T1-weighted image; T2WI, T2-weighted image.