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  • br Table br Mean CRP levels in patients and controls

    2022-05-30


    Table 2
    Mean CRP levels in patients and controls.
    Group
    Table 3
    Normal, moderate, and high CRP levels in patients and controls.
    Study group Normal levels Moderate levels High levels P value and odds ratio
    and around 17.5% of cases were suffering from triple negative breast cancer which is the most aggressive type of breast cancer.
    The Mean CRP levels for patients and controls were 1.50 ± 1.37 and 0.58 ± 0.55, respectively. Range of CRP was 0.2-6.5 mg/dl and 0-2.6 mg/dl in patients and controls respectively. The levels of CRP were significantly elevated in breast cancer patients in comparison with controls (Table 2) and showed a significant association with the disease (P < 0.0001). The distribution of patients possessing high, moderate, and normal levels has been given in Table 3. There was a signifi-cant difference in these levels between the patients and controls (Table 3). There was significant association of high CRP levels with Ac-DEVD-CHO (P < 0.02) but CRP levels did not show any significant association with ER and HER2 receptor subtypes (P > 0.05). A significant association of infiltrating ductal carcinoma and triple negative breast cancer with moderate and high lev-els of CRP was also observed (P < 0.05 in each case). CRP levels associated significantly with body mass index (obese vs underweight: P < 0.05) among breast cancer patients. However, no significant association was observed in obese vs normal and normal vs underwight (P > 0.05). Patients were divided into 3 groups based on their age that is 20-40, 40-60, and 60-80 years. High and moderate levels of CRP associated significantly with the age groups 40-60 and 60-80. However, we could not apply Mann-Whitney test on the patients belonging to the age group 20-40 as number of patients was less (only 5) in this group. There was no significant difference in the CRP levels between the pre and postmenopausal breast cancer patients. The breast cancer cases had Grade 2 (69%) or Grade 3 (27%). However, none of the patients were found to be in Grade 1. r> As per follow-up interviews metastasis and recurrence was observed in 28% of patients fol-lowed by death in 26% of cases. Disease free survival was observed in 76% of patients after 1 year of follow-up. However, this was observed to be 72% at the last follow-up. As far as overall survival is concerned 87% of patients were alive for 1 year after disease detection but this num-ber dropped to 74% an account of death, recurrence, and metastasis at the end of 27 months follow-up. Death rate associated significantly with high levels of CRP [P = 0.02; 95% CI; odds ratio: 2.75 (0.9868-7.664)]. Poor outcome that is metastasis and recurrence was found to be associated significantly with high levels of CRP [P = 0.03; 95% of CI; odds ratio: 2.954 (0.9125-9.561)].
    Discussion
    Several Ac-DEVD-CHO studies in different populations have demonstrated that CRP levels may be associ-ated with poor prognosis of different types of solid cancers like colorectal, cervical, pancre-atic, prostate, ovarian, and endometrium cancer.14–17 Emerging evidence suggests that inflam-mation pathway plays a major role in the breast cancer progression in spite of the fact that breast cancers are rarely characterized by significant histologic inflammation. A recent study published by Wang et al, has demonstrated the role of established prognostic markers including carcinoembryonic antigen, cancer antigen-15.3, cyclopentyladenosine, Tissue polypeptide specific antigen (TPS), and interleukin-6 in breast cancer. This study reported decreased sensitivity and specificity of each marker and advised that combination of 2 makers can be used to assess the poor outcome among patients.18 However, in comparison to these markers CRP assessment is a simple and inexpensive prognostic marker in breast cancer.19 Several epidemiological studies have also demonstrated the association between CRP and breast cancer risk.3,8 However, there have been discrepancies in results of different studies evaluating the association of CRP with breast cancer in various ethnic groups.8,9 Some studies have shown an association of elevated CRP and poor prognosis whereas others did not find an association.2,20,21 The largest study was carried out by Guo et al, involving a total of 5286 breast cancer patients. This meta-analysis indicated that increased CRP levels are associated with increased risk of breast cancer.2