C-Reactive Protein Levels After Esophagectomy are Associated with Increased Surgical Complications and Poor Prognosis in Esophageal Squamous Cell Carcinoma Patients

• Published in: Annals of surgical oncology 2023-03, Vol.30 (3), p.1554-1563
• Main Authors: Harada, Kazuto, Matsumoto, Chihiro, Toihata, Tasuku, Kosumi, Keisuke, Iwatsuki, Masaaki, Baba, Yoshifumi, Ohuchi, Mayuko, Eto, Kojiro, Ogawa, Katsuhiro, Sawayama, Hiroshi, Iwagami, Shiro, Miyamoto, Yuji, Yoshida, Naoya, Baba, Hideo
• Format: Article
• Language: English
• Subjects: C-reactive protein; C-Reactive Protein - metabolism; Complications; Esophageal cancer; Esophageal Neoplasms; Esophageal Squamous Cell Carcinoma; Esophagectomy - adverse effects; Humans; Medical prognosis; Medicine; Medicine & Public Health; Oncology; Patients; Postoperative; Prognosis; Regression analysis; Retrospective Studies; Squamous cell carcinoma; Surgery; Surgical Oncology; Thoracic Oncology
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-022-12831-3

Background C-reactive protein (CRP) levels are reported to predict complications and survival after surgery in various cancers. However, the relationship between postoperative CRP levels and short- and long-term outcomes of esophageal squamous cell carcinoma (ESCC) patients after esophagectomy is unclear. Method We reviewed the records of 543 ESCC patients who underwent subtotal esophagectomy with gastric conduit reconstruction at Kumamoto University Hospital between August 2010 and July 2021. Blood tests for CRP were done on postoperative days (PODs) 1, 3, 5 or 6, and 7 or 8. Results The mean CRP levels on day 1, day 3, day 5/6, and day 7/8 were 6.68 ± 0.13 mg/dL, 11.49 ± 0.27 mg/dL, 7.48 ± 0.26 mg/dL, and 5.38 ± 0.22 mg/dL, respectively. Mean CRP levels were highest on day 3, and CRP levels after day 3 correlated with grade >2 complications based on the Clavien–Dindo classification. Receiver operating characteristic curve analysis established the optimal cut-off value for CRP day 3 levels to be 12.19 mg/dL. Multivariate logistic regression analyses found that high CRP day 3 levels significantly correlated with grade >2 complications (odds ratio [OR] 3.77, 95% confidence interval [CI] 2.56–5.35; p  3.52) correlated with postoperative survival, and based on multivariate logistic regression analyses, were significantly associated with poor prognosis (hazard ratio 1.67, 95% CI 1.14–2.43; p = 0.008). Conclusion Our findings suggest CRP day 3 levels as a potential biomarker for predicting postoperative complications and that CRP day 7/8 levels have potential prognostic value for ESCC patients after esophagectomy.