Group 3 - Journal Clinical Chem

CLINICAL CHEMISTRY II
Journal
Prof. Ma. Cecilia Calisang
Submitted by:
Joven, Darylle Luise
Lapig, Aira Bhea
Lee, Atasha
Lising, Brian
Madrilejo, Hannah
Mazo, Na’arah Y.
Journal 1
Paper Context: CRP in association with cancer

Reference/ Journal: Role of C-reactive protein in urological cancers: A useful biomarker for predicting
outcomes
Saito, K., & Kihara, K. (2012). Role of C‐reactive protein in urological cancers: A useful biomarker for
predicting outcomes. International Journal of Urology, 20(2), 161–171. https://doi.org/10.1111/j.1442‐
2042.2012.03121.x
Abstract and Introduction from the Journal

Based on increasing evidence of the association between cancer‐related inflammation and the
progression of cancer, the external symptoms of systemic inflammatory response has been shown to be
an indicator for the prognosis of many malignancies, including urological cancers. C‐reactive protein, a
representative acute‐phase reactant, is a significant and sensitive inflammatory marker that can be
objectively measured using reliable assays in clinical practice worldwide. C‐reactive protein has been
shown to be significant in the prediction of outcomes of urological cancers. The elevation of C‐reactive
protein levels, which indicate the presence of cancer‐associated systemic inflammatory response, is
linked to poorer survival in patients with urological cancers, including renal cell carcinoma, upper urinary
tract and bladder cancers, and prostate cancer. With this strong prognostic ability, C‐reactive protein can
be incorporated into prognostic models and will make them simpler and improve their predictive
accuracy. Furthermore, the longitudinal change of C‐reactive protein level, C‐reactive protein kinetics,
provides additional information on patient survival outcomes. As such, C‐reactive protein can be used to
monitor treatment efficacy and disease course using serial measurements. In testicular cancer, C‐reactive
protein is associated with a risk of late complications, such as cardiovascular disease, and with the
development of second non‐germ‐cell cancer. Taken together, these findings show that C‐reactive
protein can act as an important biomarker for urological cancers. This review discusses the importance
of C‐reactive protein as a prognostic biomarker in urological cancers on the basis of the currently
available evidence.
Among the various cancer‐related features, inflammation‐associated factors have been considered as
potential biomarkers, based on the evidence that underlying inflammatory processes play important
roles in cancer progression. The presence of systemic inflammation indicated by levels of acute‐phase
reactant proteins has been shown to predict poor prognosis in various cancers. Among the inflammatory
markers, CRP, a representative acute‐phase reactant, has a significant impact on the prognosis of many
cancers, including urological cancers. Furthermore, the CRP kinetics of dynamic changes in CRP levels can
be used to monitor the disease course, such as the effect of treatment intervention or further
progression. CRP could thus serve as a useful biomarker for cancer.
Conclusions from the journal
CRP, a representative marker for systemic inflammatory response, has a significant impact in predicting
outcomes of urological cancer.
The current evidence that suggests that inflammation is involved in the pathogenesis of cancer
progression supports the strong association between the presence of systemic inflammatory response as
evidenced by elevated CRP level and poor outcome in urological cancers.
Based on its strong prognostic power, CRP can realize simpler prognostic algorithms that retain their
predictive abilities with established parameters, as demonstrated for RCC and UC. By including CRP in
prognostic algorithms, the estimation of individual risk and the stratification of patients for clinical trials
are made easier.
Serial measurement of CRP is also useful for monitoring the disease course, such as the effect of
treatment intervention or further progression. For example, CRP kinetics, presented with a stratification
model of longitudinal changes in CRP levels according to baseline and nadir CRP levels, could add further
information that would enable an evaluation of the clinical course of urological cancer. Further
application of serial CRP level changes, such as their incorporation into prognostic algorithms and
decision trees, is warranted as it would enable clinicians to assess CRP levels and would be a useful tool
in the management of urological cancers.
These findings allow us to conclude that CRP might serve as a useful biomarker for urological cancers
and that it satisfies the 2001 NIH criteria. CRP is already measured objectively and affordably in clinical
practice worldwide. CRP can be used as an indicator of disease outcome and to monitor the disease
course. A better understanding of the association between the presence of systemic inflammatory
response and cancer progression might provide insights into novel cancer therapeutics. Anti‐
inflammatory therapeutics that target the tumor microenvironment might also be considered in the
future.
Journal 2
Paper Context: CRP in association with cancer

Reference/ Journal: High-Sensitivity C-Reactive Protein and Cancer
Lee, S., Choe, J., Kim, H., & Sung, J. (2011). High‐Sensitivity C‐Reactive protein and cancer. Journal of
Epidemiology, 21(3), 161–168. https://doi.org/10.2188/jea.je20100128
Abstract, methods and results from the paper

High‐sensitivity C‐reactive protein (hs‐CRP) is a commonly used inflammatory marker. The association
between hs‐CRP and cancer is less consistent than that between hs‐CRP and cardiovascular diseases.
This study explored the association between hs‐CRP and cancer, using a large database of Korean health
examination records.
A total of 80 781 Koreans who visited the health promotion center of a general hospital were included.
There were 729 cases of cancer of any primary site during a 3‐year period. Subjects with a known cancer
or a condition capable of affecting hs‐CRP were excluded.
Serum hs‐CRP was significantly higher in cancer cases (2.9 mg/L) than in non‐cases (1.4 mg/L; P <
0.0001). With the lowest hs‐CRP category (<1 mg/L) as reference, the crude odds ratios (ORs) for cancer
were 1.36 (95% confidence interval [CI] = 1.16–1.62) for the second highest category (1–3 mg/L) and
2.49 (95% CI = 2.02–3.07) for the highest category (>3 mg/L), and the adjusted ORs for cancer were 1.16
(95% CI = 0.95–1.42) for the second highest category and 1.94 (95% CI = 1.51–2.51) for the highest
category. After excluding cancer cases detected within 1 year after the check‐up, the associations
remained, although the reduced number of cancer cases (n = 88) attenuated the significance of the
associations.
Conclusions from the paper
Serum hs‐CRP was positively associated with the risk of cancer, although causality cannot be inferred in
this cross‐sectional study. The results support the hypothesis that chronic inflammation plays a role in
cancer.

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CLINICAL CHEMISTRY II

Joven, Darylle Luise

Lapig, Aira Bhea

Paper Context: CRP in association with cancer

Abstract and Introduction from the Journal

Paper Context: CRP in association with cancer

Abstract, methods and results from the paper

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