The crucial role of high C-reactive protein interval and Glasgow prognostic score for predicting prognosis in esophageal cancer patients undergoing chemoradiotherapy

Our aim was to draw attention to the dominant role of C-reactive protein (CRP) on prognosis by examining the effect of the high CRP interval, Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS) and CAR (CRP to albumin ratio)  in patients undergoing chemoradiotherapy (CRT).

85 patients, with the diagnosis of esophageal cancer and who were scheduled for neoadjuvant or definitive CRT, were included in the study. CRP levels of each patient during the follow-up period were determined separately, and the total number of days for which serum CRP levels were > 5 mg/L was expressed as "days when CRP>5". The effects of the GPS, mGPS, CAR, and‘’days when CRP>5’’ on the prognosis and survival of these patients with esophageal cancer were analyzed in this retrospective study.

In the survival analysis, CAR (p=0.007), GPS (p<0.001), mGPS (p<0.001) and ‘’days when CRP > 5’’ (p=0.002) were determined to be independent predictive factors for mortality. In the long-rank test results, it was observed that the patients with GPS 0 and mGPS 0 had longer overall survival than the others (p < 0.001). In addition, with the increase in ‘’days when CRP>5’’, disease recurrence also increased significantly (p = 0.01). Similarly, in the ROC analysis, the area under the curve (AUC) was significant for the ‘’days when CRP>5’’ (AUC: 0.956, 95% CI: 0.915‒0.998; P < 0.001).

In patients diagnosed with esophageal cancer, beginning from the pretreatment period and throughout the follow-up period, serum CRP levels are an independent factor in predicting survival, both in terms of the number of days it is high and in terms of the scoring systems it is associated with.