Prognostic value of C-reactive protein and other classical factors in patients with advanced non-small cell lung carcinoma treated in routine clinical practice

Background: Prognostic factors may help the clinician in treatment decision making. The significance of C-reactive protein (CRP) as a negative prognostic factor has been shown in patients with different malignancies. However, only few studies have analyzed CRP as a prognostic factor in patients with advanced non-small cell lung cancer (NCLCS). The aim of this study was to evaluate the prognostic value of CRP and other prognostic factors in a group of unselected population of patients with advanced NCLSC treated with platinum based chemotherapy. Methods: The retrospective study was conducted by reviewing 53 medical files of advanced NSCLC patients treated with platinum/gemcitabine at the University Clinic Golnik between May 2004 and November 2008. The median age of patients was 65 years, most of them were males (75 %), smokers or ex-smokers (81 %), with performance status 1 ( 64.2 %) and stage IV disease (83 %). The collected data included laboratory characteristics (Hb, platelet count, CRP, LDH) before chemotherapy, information on each individual patient‘s therapy and outcome. The median number of chemotherapy cycles received was 4 (range, 1–6). Results: The median progression free survival (PFS) for the entire group was 4.8 months (range 0–20 months). Patients with elevated CRP levels (≥ 20 mg/l) had inferior PFS compared to those with low pretreatment CRP values (median PFS 8.4 vs 3.6 months, p=0.006). In Cox univariate regression analysis, CRP (p=0.016, HR=1.008, 95 %CI, 1.001–1.014), Hb (p=0.001, HR= 0.96, 95 %CI, 0.95–0.99), and comorbidity (p=0.051, HR=1.2, 95 %CI, 1.00 -1.45) were found to be significant prognostic factors; age, LDH, and platelet count on the other hand were not found to be significant prognostic factors. In multivariate analysis only CRP (p=0.048, HR=0.50, 95 %CI 0.26–0.99) and Hb (p=0.005, HR=0.97, 95 %CI, 0.95 -0.99) retained their independent prognostic value. Conclusion: The survival of patients with advanced NSCLC treated by chemotherapy is significantly influenced by the patient‘s pretreatment CRP and Hb levels, and comorbidity only borderline so. The major advantage of this study is that it was performed on an unselected population of patients, but still uniform with respect to diagnosis, stage and agents used in chemotherapy treatment schedule.