Prognostic value of combined glucose and C-reactive protein (CRP) in cervical cancer

Objective: In this study, we aimed to reveal the prognostic importance of glucose and C-reactive protein (CRP) together in cervical cancer, both of which play a critical role in carcinogenesis. Methods: A total of 243 patients who fulfilled the inclusion criteria were included in our study. The effect of fasting blood glucose (FBG) and C-reactive protein (CRP) on survival was evaluated separately as a dichotomous variable by finding the optimal cutoff value. Results: While 31.3% of the patients were in the early stage, 68.7% were in the locally advanced stage. The median follow-up time was 70.2 months (min: 0.57–max: 231). When the locally advanced stage and all stages were included in the analysis, there was a statistically significant difference between the 4 groups in both progression free survival (PFS) and overall survival (OS) (p: 0.026, p: 0.005, p: 0.001 and p: 0.0001, respectively). The HgLc [High fasting blood glucose (FBG) ( $\geq$ 94.5 mg/dL), Low C-reactive protein (CRP) ( $<$ 0.9585 mg/dL)], HgHc [High FBG ( $\geq$ 94.5 mg/dL) and High CRP ( $\geq$ 0.9585 mg/dL)] groups were found to be independent prognostic risk factors for OS, compared to the LgLc [(Low FBG ( $<$ 94.5 mg/dL) and Low CRP ( $<$ 0.9585 mg/dL)], in locally advanced stage (HR (Hazard Ratio): 2.95 (95% CI; 1.04–8.40), p: 0.042 and HR: 3.63 (95% CI; 1.39–9.47), p: 0.008, respectively). In the multivariate analysis performed for all stages, among the four groups, only the HgHc group was found to be an independent prognostic risk factor for OS (HR for HgHc group: 2.34 (95% CI; 1.14–4.78), p: 0.019). Conclusions: We found that combined high serum fasting blood glucose (FBG) and C-reactive protein (CRP) levels in cervical cancer, especially in the locally advanced stage, negatively affect the progression free and overall survival, and are independent prognostic risk factors affecting survival. The pre-treatment serum FBG and CRP levels should be carefully evaluated together for each cervical cancer patient. The vital importance of preoperative strict glycemic control for these patients should be considered.