Journal Article

Circulating C-reactive protein levels as a prognostic biomarker in breast cancer across body mass index groups

Borgquist, S., Holm, J. B., Christiansen, P., Cronin-Fenton, D., Bruun, J. M., Frystyk, J., Baggesen, E.

2024

Overview

Obesity and systemic inflammation are associated with breast cancer (BC) outcomes. Systemic inflammation is increased in obesity. We examined the association between C-reactive protein (CRP) and disease-free survival (DFS) and overall survival (OS) overall, and according to body mass index (BMI). We assembled a cohort of women with BC (stage I–III) seen at Aarhus University Hospital between 2010 and 2020 who donated blood at BC diagnosis (N = 2673). CRP levels were measured and divided into quartiles. We followed patients from surgery to recurrence, contralateral BC, other malignancy, death, emigration, or end-of-follow-up. We used Cox regression to estimate hazard ratios (HRs) with 95% confidence intervals (95% CIs) to compare outcomes across CRP quartiles, overall and stratified by BMI (normal-weight (18.5 ≤ BMI < 25 kg/m 2 ), overweight (25 ≤ BMI < 30 kg/m 2 ), and obesity (BMI ≥ 30 kg/m 2 )). During follow-up, 368 events (212 recurrences, 38 contralateral BCs, and 118 deaths) occurred (median follow-up 5.55 years). For DFS, high CRP (CRP ≥ 3.19 mg/L) was associated with an increased risk of events (HR adj :1.62 [95% CI = 1.14–2.28]). In BMI-stratified analyses, high CRP was associated with elevated risk of events in normal-weight and overweight (HR adj :1.70 [95% CI = 1.09–2.66]; HR adj :1.75 [95% CI = 1.08–2.86]), but in obesity, the estimate was less precise (HR adj :1.73 [95% CI = 0.78–3.83]). For OS, high CRP was associated with increased risk of death (HR adj :2.47 [95% CI = 1.62–3.76]). The association was strong in normal-weight and overweight (HR adj :3.66 [95% CI = 1.95–6.87]; HR adj :1.92 [95% CI = 1.06–3.46]), but less clear in obesity (HR adj :1.40 [95% CI = 0.64–3.09]). To sum up, high CRP levels at BC diagnosis were associated with inferior prognosis in early BC irrespective of BMI, although less clear in patients with obesity.

• Publisher: Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
• Subject: 692/4028/67/1347 / 692/4028/67/2324 / 692/53/2422 / 692/699/67/1347 / 692/699/67/2324 / Adult / Aged / Biomarkers, Tumor - blood / Body Mass Index / Body weight / Breast cancer / Breast Neoplasms - blood / Breast Neoplasms - diagnosis / Breast Neoplasms - mortality / C-reactive protein / C-Reactive Protein - analysis / C-Reactive Protein - metabolism / Diagnosis / Disease-Free Survival / Emigration / Female / Humanities and Social Sciences / Humans / Inflammation / Inflammation - blood / Malignancy / Medical prognosis / Middle Aged / multidisciplinary / Neoplasm Recurrence, Local - blood / Obesity / Obesity - blood / Obesity - complications / Overweight / Patients / Prognosis / Science / Science (multidisciplinary) / Survival