Erythrocyte Sedimentation Rate and C-Reactive Protein are Markers for Tumor Aggressiveness and Survival in Patients with Hepatocellular Carcinoma

Introduction: Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are acute phase reactants in clinical use for monitoring inflammatory diseases for several decades. CRP is also prognostically useful in several cancers. Objective: To evaluate the role of ESR as a possible indicator of tumor biology and survival in patients with hepatocellular carcinoma (HCC). Methods: A large cohort of HCC patients in Turkey was examined retrospectively for clinical and tumor characteristics with respect to blood CRP and ESR levels. Results: Portal vein thrombosis and high Aggressiveness Index were significantly related to elevated CRP or ESR levels and especially to the combination of elevated CRP and ESR, both in the total cohort and in patients with small tumors <5cm. A final logistic regression model of an Aggressiveness Index score gave an Odds Ratio of 10.37 for the ESR and CRP combination, compared to the reference category. Furthermore, a Cox regression model on death gave a Hazard Ratio of 2.53 for the ESR and CRP combination versus the reference category for each of them (p<0.001). A significant Hazard Ratio for the ESR and CRP combination was also found for patients with low alpha-fetoprotein. Conclusions: ESR is a useful biomarker for HCC extent and survival, especially in combination with CRP, in patients with small or large tumors and with elevated or low serum alpha-fetoprotein.