C-reactive protein is an independent predictor for hepatocellular carcinoma recurrence after liver transplantation

PLoS One. 2019 May 29;14(5):e0216677. doi: 10.1371/journal.pone.0216677. eCollection 2019.

Abstract

Background: Serum C-reactive protein (CRP) is a prognostic factor for overall survival (OS) and recurrence of hepatocellular carcinoma (HCC) in patients treated with resection or non-surgical treatment. Here, we investigated the association of elevated CRP (≥1 vs. <1 mg/dL) with (i) recurrence of HCC and (ii) OS after liver transplantation (LT).

Methods: Adult HCC patients undergoing orthotopic deceased donor LT at the Medical University of Vienna between 1997 and 2014 were retrospectively analysed.

Results: Among 216 patients included, 132 (61.1%) were transplanted within the Milan criteria and forty-two patients (19.4%) had microvascular invasion on explant histology. Seventy patients (32.4%) showed elevated CRP (≥ 1 mg/dL). On multivariate analysis, a CRP ≥ 1 mg/dL was an independent risk factor for HCC recurrence with a 5-year recurrence rate of 27.4% vs. 16.4% (HR 2.33; 95% CI 1.13-4.83; p = 0.022). OS was similar in patients with normal vs. elevated CRP levels.

Conclusions: Elevated serum CRP is associated with HCC recurrence after LT and may be a marker for more aggressive tumor biology. Future studies should evaluate whether patients with elevated pre-transplant CRP levels benefit from closer monitoring for HCC recurrence.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers, Tumor / blood
  • C-Reactive Protein / analysis
  • C-Reactive Protein / metabolism*
  • Carcinoma, Hepatocellular / metabolism*
  • Carcinoma, Hepatocellular / pathology
  • Disease-Free Survival
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Liver / pathology
  • Liver Neoplasms / metabolism
  • Liver Neoplasms / pathology
  • Liver Transplantation
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / metabolism*
  • Prognosis
  • Retrospective Studies
  • Risk Factors

Substances

  • Biomarkers, Tumor
  • C-Reactive Protein

Grants and funding

The authors received no specific funding for this work.