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C-Reactive Protein As a Marker of Melanoma Progression

Shenying Fang, Yuling Wang, Dawen Sui, Huey Liu, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Christopher W. Schacherer, et al.

Article in Press

Abstract

Purpose
To investigate the association between blood levels of C-reactive protein (CRP) in patients with melanoma and overall survival (OS), melanoma-specific survival (MSS), and disease-free survival.

Patients and Methods
Two independent sets of plasma samples from a total of 1,144 patients with melanoma (587 initial and 557 confirmatory) were available for CRP determination. Kaplan-Meier method and Cox regression were used to evaluate the relationship between CRP and clinical outcome. Among 115 patients who underwent sequential blood draws, we evaluated the relationship between change in disease status and change in CRP using nonparametric tests.

Results
Elevated CRP level was associated with poorer OS and MSS in the initial, confirmatory, and combined data sets (combined data set: OS hazard ratio, 1.44 per unit increase of logarithmic CRP; 95% CI, 1.30 to 1.59; P < .001; MSS hazard ratio, 1.51 per unit increase of logarithmic CRP; 95% CI, 1.36 to 1.68; P < .001). These findings persisted after multivariable adjustment. As compared with CRP < 10 mg/L, CRP ≥ 10 mg/L conferred poorer OS in patients with any-stage, stage I/II, or stage III/IV disease and poorer disease-free survival in those with stage I/II disease. In patients who underwent sequential evaluation of CRP, an association was identified between an increase in CRP and melanoma disease progression.

Conclusion
CRP is an independent prognostic marker in patients with melanoma. CRP measurement should be considered for incorporation into prospective studies of outcome in patients with melanoma and clinical trials of systemic therapies for those with melanoma.

Footnotes
Supported by National Cancer Institute Specialized Programs of Research Excellence Grant No. P50 CA093459, Developmental Research Program No. P50 CA093459, Aim at Melanoma Foundation, and philanthropic contributions to the University of Texas MD Anderson Cancer Center Moon Shots Program, Miriam and Jim Mulva Research Fund, and Marit Peterson Fund for Melanoma Research.