Background: A number of studies have investigated the association between increased pretreatment serumC-reactive protein (CRP) levels and the prognosis of gastric cancer. However, due to the inconsistent results,whether the serum CRP level can be a prognostic factor in primary gastric cancer remains controversial. Methods: We searched Medline, PubMed, Embase and the Cochrane Central Register of Controlled Trials forrelevant high-quality reports. A meta-analysis was carried out using the included studies to assess the associationbetween pretreatment serum CRP level and overall survival (OS) in patients with gastric cancer. Correlationanalyses were conducted to evaluate the relationship between serum CRP and tumor characteristics such astumor node metastasis (TNM) stage and recurrence. Results: Twelve reports involving 2,597 patients with gastriccancer were included. Primary meta-analysis indicated a significant association between elevated CRP leveland poor OS (HR 1.77, 95% CI 1.56-2.00). Subgroup analyses showed no single factor could alter the primaryresults when we divided the included studies by “number of patients”, “max follow-up period”, “TNM stage”,“treatment” and “cut-off value”. Correlation analyses showed that serum CRP level was significantly related toTNM stage (OR 2.96, 95% CI 2.22-3.93) and tumor recurrence (OR 1.81, 95% CI 1.21-2.71). Conclusions: Wedemonstrated that increased pretreatment serum CRP level (≥10mg/L) was significantly associated with poorprognosis in gastric cancer patients, either in early or advanced stages.
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