Prognostic Significance of C-reactive Protein in Urological Cancers: a Systematic Review and Meta-analysis

Background: C-reactive protein (CRP), considered as a prototypical inflammatory cytokine, has beenproposed to be involved in tumor progression through inflammation. Recent studies have indicated CRP asa progostic predictor for urological cancers, but the results remain controversial. Materials and
Methods: Asystematic search of Medline, Scopus and the Cochrane Library was performed to identify eligible studiespublished between Jan 1, 2001 and Sep 1, 2013. Outcomes of interest were collected from studies comparingoverall survival (OS), cancer-specific survival (CSS) and relapse-free survival (RFS) in patients with elevatedCRP levels and those having lower levels. Studies were pooled, and combined hazard ratio (HR) of CRP withits 95% confidence interval (CI) for survival were used for the effect size estimate.
Results: A total of 43 studies(7,490 patients) were included in this meta-analysis (25 for RCC, 10 for UC, and 8 for PC). Our pooled resultsshowed that elevated serum CRP level was associated with poor OS (HR: 1.26, 95%CI: 1.22-1.30) and RFS (HR:1.38 95%CI: 1.29-1.47), respectively. For CSS the pooled HR (HR: 1.33, 95%CI: 1.28-1.39) for higher CRPexpression could strongly predict poorer survival in urological cancers. Simultaneously, elevated serum CRPwas also significantly associated with poor prognosis in the subgroup analysis.
Conclusions: Our pooled resultsdemonstrate that a high serum level of CRP as an inflammation biomarker denotes a poor prognosis of patientswith urological cancers. Further large prospective studies should be performed to confirm whether CRP, as abiomarker of inflammation, has a prognostic role in urological cancer progression.