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Open Access Research article

High CRP values predict poor survival in patients with penile cancer

Sandra Steffens1*, Andreas Al Ghazal2, Julie Steinestel2, Rieke Lehmann1, Gerd Wegener3, Thomas J Schnoeller2, Marcus V Cronauer2, Florian Jentzmik2, Mark Schrader2, Markus A Kuczyk1 and Andres J Schrader2

Author Affiliations

1 Department of Urology, Hannover Medical School, Hannover, Germany

2 Department of Urology, Ulm University Medical Center, Pritzwitzstrasse 43, Ulm, D-89075, Germany

3 Cancer Center, Hannover Medical School, Hannover, Germany

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BMC Cancer 2013, 13:223  doi:10.1186/1471-2407-13-223

Published: 3 May 2013

Abstract

Background

High levels of circulating C-reactive protein (CRP) have recently been linked to poor clinical outcome in various malignancies. The aim of this study was to evaluate the prognostic significance of the preoperative serum CRP level in patients with squamous cell carcinoma (SCC) of the penis.

Methods

This retrospective analysis included 79 penile cancer patients with information about their serum CRP value prior to surgery who underwent either radical or partial penectomy at two German high-volume centers (Ulm University Medical Center and Hannover Medical School) between 1990 and 2010. They had a median (mean) follow-up of 23 (32) months.

Results

A significantly elevated CRP level (>15 vs. ≤ 15 mg/l) was found more often in patients with an advanced tumor stage (≥pT2) (38.9 vs. 11.6%, p=0.007) and in those with nodal disease at diagnosis (50.0 vs. 14.6%, p=0.007). However, high CRP levels were not associated with tumor differentiation (p=0.53). The Kaplan-Meier 5-year cancer-specific survival (CSS) rate was 38.9% for patients with preoperative CRP levels above 15 mg/l and 84.3% for those with lower levels (p=0.001). Applying multivariate analysis and focusing on the subgroup of patients without metastasis at the time of penile surgery, both advanced local tumor stage (≥pT2; HR 8.8, p=0.041) and an elevated CRP value (>15 mg/l; HR 3.3, p=0.043) were identified as independent predictors of poor clinical outcome in patients with penile cancer.

Conclusions

A high preoperative serum CRP level was associated with poor survival in patients with penile cancer. If larger patient populations confirm its prognostic value, its routine use could enable better risk stratification and risk-adjusted follow-up of patients with SCC of the penis.

Keywords:
SCC; Penis; Penile cancer; Biomarker; C-reactive protein; Prognosis; Survival