Serum high sensitivity c-reactive protein as a prognostic and therapeutic marker in advanced stage non-small cell lung cancer

Introduction: CRP is shown to be elevated in many malignancies including lung cancer. In patients of NSCLC, elevated CRP levels prior to therapy are related with bad prognosis. Studies have shown that high CRP is also related to advanced stages. CRP level is much higher in malignancy cases than only inflammatory condition like COPD. In cancer, CRP is possibly increased by tissue inflammation and cytokines released by tumor cells indicating a higher tumor burden. Objective: This study was designed to evaluate serum mean hs-CRP levels in advanced stage NSCLC at diagnosis, after every 2 cycles of chemotherapy and to correlate this with treatment response. Baseline hs-CRP with correlated with tumor stage and T size and also compared with baseline levels in patients of COPD and healthy controls. Material and Methods: This Hospital based observational study included 20 newly diagnosed patients of NSCLC (stage IIIB and IV) in good PS, 20 patients of stable COPD and 20 healthy controls. Baseline hs-CRP values were compared among three groups. NSCLC cases were assessed for baseline hs-CRP, tumor size, subtypes, staging and treatment response. After every 2 cycles of chemotherapy, parameters were reassessed and compared. hs-CRP was tested by routine clinical lab test protocols using instrument Labmate and tumor response was assessed using the RECIST 1.1 criteria. Results: Baseline mean hs-CRP values of NSCLC, COPD, controls were 28.11±16.02 mg/L, 8.59±3.53 mg/L,0.60±0.30 mg/L respectively (p<0.001). Squamous Cell Carcinoma (SCC) had significantly higher CRP as compared to adenocarcinoma, and NSCLC-NOS. No statistical significance was found between SCC and large cell ca. After treatment, 15% had CR, 35% had PR, 25% had SD and 25% had PD. Baseline mean hs-CRP values in patients with CR, PR, SD and PD groups were 8.13±.80 mg/L,19.27±2.99 mg/L,29.60±6.2 mg/L and 50.98±8.6 mg/L (p<0.001).This statistical significant difference was also noted post 2nd, 4th & 6th cycle of chemotherapy. Significant difference was noted in baseline mean tumor size and mean baseline hs-CRP (cut off 7cm). Strong correlation was found in change in mean tumor size and mean hs-CRP during treatment in all treatment response groups(r > 0.8). Conclusion: Despite the small number of patients in our study, we conclude the following. A high CRP value could suggest an occult lung cancer in patients of COPD. Higher stages at diagnosis have high level of CRP. Patients with high baseline tumor size have high level of baseline CRP. During treatment change in hs-CRP and change in tumor size have strong correlation. Patients having high baseline hs-CRP level are less likely to respond to chemotherapy and have progressive disease. hs-CRP might be useful for monitoring treatment response in Ca lung.