Yonsei Med J.  2013 Mar;54(2):396-402. 10.3349/ymj.2013.54.2.396.

Diagnostic Value and Prognostic Significance of Pleural C-Reactive Protein in Lung Cancer Patients with Malignant Pleural Effusions

• Park DS
• Kim D
• Hwang KE
• Hwang YR
• Park C
• Seol CH
• Cho KH
• Kim BR
• Park SH
• Jeong ET
• Kim HR

• KMID: 1503902
• DOI: http://doi.org/10.3349/ymj.2013.54.2.396

Abstract

PURPOSE
C-reactive protein (CRP) has been implicated in various inflammatory and advanced malignant states. Increased serum CRP (s-CRP) levels have been shown to be associated with independent prognostic factors for survival in patients with advanced lung cancer. However, only few studies have focused on the role of CRP in pleural effusions. This study aimed to evaluate the diagnostic and prognostic value of pleural CRP (p-CRP) in lung cancer patients with malignant pleural effusion (MPE).
MATERIALS AND METHODS
Pleural effusion (PE) samples were collected from patients with MPE (68 lung cancers; 12 extrathoracic tumors), and from 68 patients with various benign conditions (31 with pneumonia; 37 with tuberculosis). Concentrations of p- and s-CRP were measured by enzyme-linked immunosorbent assay. CRP level in pleural fluid and its association with survival were examined.
RESULTS
p-CRP levels correlated with s-CRP levels (r=0.82, p<0.0001). For the differential diagnosis of MPE and benign PE, the area under the receiver operating characteristic curve was greater for p-CRP (0.86) than for s-CRP (0.77). High p-CRP expression significantly correlated with shorter overall survival (p=0.006). P-CRP was independent prognostic factor significantly associated with overall survival on multivariated analysis (p=0.0001). The relative risk of death for lung cancer patients with high p-CRP levels was 3.909 (95% confidence interval, 2.000-7.639).
CONCLUSION
P-CRP is superior to s-CRP in determining pleural fluid etiology. Quantitative measurement of p-CRP might be a useful complementary diagnostic and prognostic test for lung cancer patients with MPE.

Keyword

Pleural CRP; diagnosis; prognosis; lung cancer; pleural effusion

MeSH Terms

C-Reactive Protein/*metabolism
Enzyme-Linked Immunosorbent Assay
Humans
Lung Neoplasms/*diagnosis/metabolism/pathology
Multivariate Analysis
Pleural Effusion, Malignant/*diagnosis/metabolism/pathology
Predictive Value of Tests
Prognosis
Survival Analysis
C-Reactive Protein

Figure

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  Fig. 1 Correlation between p- and s-CRP in PE; r is the Spearman coefficient of correlation. CRP, C-reactive protein; PE, pleural effusion; p-CRP, pleural CRP; s-CRP, serum CRP.

• 

  Fig. 2 Comparison of p-CRP vs. s-CRP levels in MPE and benign PE. CRP, C-reactive protein; MPE, malignant pleural effusion; PE, pleural effusion; p-CRP, pleural CRP; s-CRP, serum CRP.

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  Fig. 3 Comparison of diagnostic accuracies of p-CRP vs. s-CRP in distinguishing lung cancer with MPE from benign PE, using receiver operating characteristic (ROC) curves. The numbers in parentheses indicate the diagnostic accuracies (area under the ROC curve). CRP, C-reactive protein; MPE, malignant pleural effusion; PE, pleural effusion; p-CRP, pleural CRP; s-CRP, serum CRP.

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  Fig. 4 Overall survival differences between lung cancer with MPE in high and low p-CRP expression, as determined using Kaplan-Meier survival analysis. Patients in the high p-CRP expression group showed reduced overall survival. The p value was obtained from a log-rank test of the difference. CRP, C-reactive protein; MPE, malignant pleural effusion; p-CRP, pleural CRP.

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