Prognostic value of postoperative C-reactive protein elevation versus complication occurrence: a multicenter validation study

Background Several studies have shown that postoperative complications worsen the prognosis of patients with malignancies. However, our previous study showed that C-reactive protein (CRP) elevation over 12 mg/dL was a more reliable prognostic indicator than complication occurrence. This large-scale, multicenter validation study aimed to confirm the prognostic value of postoperative CRP elevation in resectable gastric cancer. Methods Data of 1456 patients with pT2-T4 gastric cancer who underwent R0 resection were collected from 21 institutions. The prognostic value of the highest postoperative serum level of CRP (CRPmax) during hospitalization was evaluated using the Kaplan-Meier method. The prognostic independence of CRPmax with assessed with a Cox multivariate analysis of recurrence-free survival (RFS). Results RFS in the high CRPmax (>= 12 mg/dL) group was significantly worse than that in the low CRPmax (< 12 mg/dL) group (log-rank P = 0.002). The recurrence pattern showed that liver metastasis occurred more frequently in the high CRPmax group (9.2%) than in the low CRPmax group (4.7%) (P = 0.001). In patients without intra-abdominal infectious complications, the high CRPmax group showed significantly worse RFS than the low CRPmax group (log-rank P = 0.026). In patients with intra-abdominal infectious complications, the high CRPmax group had worse RFS than the low CRPmax group, but this difference was not significant (log-rank P = 0.075). Cox multivariate analysis with 13 covariables showed that CRPmax (P = 0.043) was an independent prognostic factor, but postoperative complications were not (P = 0.387). Conclusion Postoperative CRP elevation was a better predictor of prognosis in patients with gastric cancer than the occurrence of intra-abdominal infectious complications.