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Serum Apolipoprotein A-I Combined With C-Reactive Protein Serves As A Novel Prognostic Stratification System For Colorectal Cancer

Authors Ye J, Luo Q, Wang X, Liu Z, Chen M, Huang H, Zhang L

Received 14 May 2019

Accepted for publication 4 October 2019

Published 30 October 2019 Volume 2019:11 Pages 9265—9276

DOI https://doi.org/10.2147/CMAR.S215599

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Nicola Ludin

Peer reviewer comments 4

Editor who approved publication: Dr Seema Singh


Juan Ye,1–3,* Qiu-yun Luo,1,* Xue-ping Wang,4 Zhen-yi Liu,5 Mei-xian Chen,6 Hao Huang,7 Lin Zhang1,4

1Department of Experimental Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China; 2Department of Infectious Diseases, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, People’s Republic of China; 3Department of Oncology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, People’s Republic of China; 4Department of Clinical Laboratory, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China; 5Department of Blood Transfusion, Peking University Shenzhen Hospital, Shenzhen, Guangdong, People’s Republic of China; 6Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China; 7Department of Laboratory Science, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Lin Zhang
Department of Clinical Laboratory, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, People’s Republic of China
Tel/Fax +86 20 8734 2285
Email zhanglin@sysucc.org.cn
 
Hao Huang
Department of Laboratory Science, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou 510080, People’s Republic of China
Tel/Fax +86 20 8733 0808
Email 836271002@qq.com

Background and objective: Noninvasive prognostic tools for colorectal cancer (CRC) are urgently needed. This study was designed to investigate the prognostic value of preoperative serum lipid and lipoprotein concentrations (including ApoA-I, Apo-B, HDL-C, LDL-C, TC and TG) and CRP levels retrospectively in CRC patients.
Methods: Preoperative serum lipid and lipoprotein concentrations (including ApoA-I, Apo-B, HDL-C, LDL-C, TC and TG) and CRP levels were analyzed retrospectively in 250 patients with CRC. The prognostic significance of these indexes was determined by univariate and multivariate Cox hazard models.
Results: CRC patients with higher levels of ApoA-I and HDL-C and lower levels of CRP had significantly longer overall survival (OS, log rank test, p<0.05). Based on univariate analysis, ApoA-I levels (p=0.002), CRP levels (p=0.007), HDL-C levels (p=0.005), pT classification (p=0.005), pN classification (p<0.001), pM classification (p<0.001) and pTNM stage (p<0.001) were significantly associated with OS. Multivariate Cox proportional hazards regression analysis indicated that ApoA-I levels (HR: 1.52, p=0.023), CRP levels (HR: 1.85, p=0.035) and pTNM stage (HR: 2.53, p< 0.001) were independent predictors of CRC survival. The included patients were then stratified into three tiers based on the ApoA-I and CRP levels. In the whole cohort, the OS and disease-free survival differed significantly between the low-risk (ApoA-I≥1.08 mg/dL and CRP<3.04 mg/dL), medium-risk (ApoA-I≥1.08 mg/dL or CRP<3.04 mg/dL), and high-risk (ApoA-I<1.08 mg/dL and CRP ≥3.04 mg/dL) groups (p=0.001 and p=0.004).
Conclusion: Decreased levels of ApoA-I and HDL-C and increased levels of CRP were predictive of poor prognosis among patients with CRC. In addition, the combination of ApoA-I and CRP can serve as a novel prognostic stratification system for more accurate clinical staging of CRC.

Keywords: apolipoprotein A-I, CRP, CRC, prognosis


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