The Prognostic Value of the Serum Level of C-Reactive Protein for Survival of Children with Ewing’s Sarcoma

Abstract

The purpose of the present study was to evaluate the prognostic role of C-reactive protein (CRP) in children with Ewing’s sarcoma. We conducted a retrospective study on 151 children undergoing multimodal treatment for Ewing’s sarcoma in the appendicular skeleton from December 1997 to June 2020. Univariate Kaplan-Meier analyses of laboratory biomarkers and clinical parameters showed that CRP and metastatic disease at presentation were poor prognostic factors associated with overall survival and disease recurrence at 5 years (p < 0.05). A multivariate Cox regression model showed that pathological CRP (≥1.0 mg/dL) [HR of 3.67; 95% CI, 1.46 to 10.42] and metastatic disease [HR of 4.27; 95% CI, 1.58 to 11.47] were associated with a higher risk of death at 5 years (p < 0.05). In addition, pathological CRP (≥1.0 mg/dL) [HR of 2.66; 95% CI, 1.23 to 6.01] and metastatic disease [HR of 2.56; 95% CI, 1.13 to 5.55] were associated with a higher risk of disease recurrence at 5 years (p < 0.05). Our findings demonstrated that CRP was associated with the prognosis of children with Ewing’s sarcoma. We recommend pre-treatment measurement of the CRP in order to recognize children with Ewing’s sarcoma who are at greater risk of death or local recurrence.

C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians

“…Even if some case reports reveal elevated CRP values in benign bone cancers, but data seem sparse, and data on Paget’s disease seem contrasted, there exists a study concluding that baseline CRP seems to be an independent predictor for the overall survival in cases with dedifferentiated chondrosarcoma [ 853 ]. Furthermore, CRP has been reported as a prognostic factor for children with Ewing’s sarcoma, chordoma, and osteosarcoma, yet a meta-analysis concluded that higher CRP expression indicates a poorer prognosis in cases with bone neoplasms—except for Asian populations [ 854 , 855 , 856 , 857 ]. Even if data on soft tissue sarcomas are somewhat sparse, a meta-analysis concluded that elevated pretreatment serum CRP level could serve as an independent risk factor for poor disease-specific survival and disease/recurrence-free survival in those patients [ 858 ].…”