Association between inflammatory biomarker C-reactive protein and radiotherapy-induced early adverse skin reactions in a multiracial/ethnic breast cancer population

Jennifer Hu, James J. Urbanic, L. Doug Case, Cristiane Takita, Jean L. Wright, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Sandra E. Mitchell, Anu Thakrar, David Bryant, Kathy Baglan, Jon Strasser, Luis Baez-Diaz, Glenn J. Lesser, Edward G. Shaw

Research output: Contribution to journalArticle

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Abstract

Purpose This study examined an inflammatory biomarker, high-sensitivity C-reactive protein (hsCRP), in radiotherapy (RT)-induced early adverse skin reactions or toxicities in breast cancer. Patients and Methods Between 2011 and 2013, 1,000 patients with breast cancer who underwent RT were evaluated prospectively for skin toxicities through the National Cancer Institute–funded Wake Forest University Community Clinical Oncology Program Research Base. Pre- and post-RT plasma hsCRP levels and Oncology Nursing Society skin toxicity criteria (0 to 6) were used to assess RT-induced skin toxicities. Multivariable logistic regression analyses were applied to ascertain the associations between hsCRP and RT-induced skin toxicities after adjusting for potential confounders. Results The study comprised 623 white, 280 African American, 64 Asian/Pacific Islander, and 33 other race patients; 24% of the patients were Hispanic, and 47% were obese. Approximately 42% and 15% of patients developed RT-induced grade 3+ and 4+ skin toxicities, respectively. The hsCRP levels differed significantly by race and body mass index but not by ethnicity. In multivariable analysis, grade 4+ skin toxicity was significantly associated with obesity (odds ratio [OR], 2.17; 95% CI, 1.41 to 3.34], post-RT hsCRP $ 4.11 mg/L (OR, 1.61; 95% CI, 1.07 to 2.44), and both factors combined (OR, 3.65; 95% CI, 2.18 to 6.14). Above-median post-RT hsCRP (OR, 1.93; 95% CI, 1.03 to 3.63), and change in hsCRP (OR, 2.80; 95% CI, 1.42 to 5.54) were significantly associated with grade 4+ skin toxicity in nonobese patients. Conclusion This large prospective study is the first to our knowledge of hsCRP as an inflammatory biomarker in RT-induced skin toxicities in breast cancer. We demonstrate that nonobese patients with elevated RT-related change in hsCRP levels have a significantly increased risk of grade 4+ skin toxicity. The outcomes may help to predict RT responses and guide decision making.

Original languageEnglish (US)
Pages (from-to)2473-2482
Number of pages10
JournalJournal of Clinical Oncology
Volume36
Issue number24
DOIs
StatePublished - Aug 20 2018

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C-Reactive Protein
Radiotherapy
Biomarkers
Breast Neoplasms
Skin
Population
Odds Ratio
Nursing Societies
Oncology Nursing
Medical Oncology
Hispanic Americans
African Americans
Decision Making
Body Mass Index
Obesity
Logistic Models
Regression Analysis
Prospective Studies

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Association between inflammatory biomarker C-reactive protein and radiotherapy-induced early adverse skin reactions in a multiracial/ethnic breast cancer population. / Hu, Jennifer; Urbanic, James J.; Doug Case, L.; Takita, Cristiane; Wright, Jean L.; Brown, Doris R.; Langefeld, Carl D.; Lively, Mark O.; Mitchell, Sandra E.; Thakrar, Anu; Bryant, David; Baglan, Kathy; Strasser, Jon; Baez-Diaz, Luis; Lesser, Glenn J.; Shaw, Edward G.

In: Journal of Clinical Oncology, Vol. 36, No. 24, 20.08.2018, p. 2473-2482.

Research output: Contribution to journalArticle

Hu, J, Urbanic, JJ, Doug Case, L, Takita, C, Wright, JL, Brown, DR, Langefeld, CD, Lively, MO, Mitchell, SE, Thakrar, A, Bryant, D, Baglan, K, Strasser, J, Baez-Diaz, L, Lesser, GJ & Shaw, EG 2018, 'Association between inflammatory biomarker C-reactive protein and radiotherapy-induced early adverse skin reactions in a multiracial/ethnic breast cancer population', Journal of Clinical Oncology, vol. 36, no. 24, pp. 2473-2482. https://doi.org/10.1200/JCO.2017.77.1790
Hu, Jennifer ; Urbanic, James J. ; Doug Case, L. ; Takita, Cristiane ; Wright, Jean L. ; Brown, Doris R. ; Langefeld, Carl D. ; Lively, Mark O. ; Mitchell, Sandra E. ; Thakrar, Anu ; Bryant, David ; Baglan, Kathy ; Strasser, Jon ; Baez-Diaz, Luis ; Lesser, Glenn J. ; Shaw, Edward G. / Association between inflammatory biomarker C-reactive protein and radiotherapy-induced early adverse skin reactions in a multiracial/ethnic breast cancer population. In: Journal of Clinical Oncology. 2018 ; Vol. 36, No. 24. pp. 2473-2482.
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abstract = "Purpose This study examined an inflammatory biomarker, high-sensitivity C-reactive protein (hsCRP), in radiotherapy (RT)-induced early adverse skin reactions or toxicities in breast cancer. Patients and Methods Between 2011 and 2013, 1,000 patients with breast cancer who underwent RT were evaluated prospectively for skin toxicities through the National Cancer Institute–funded Wake Forest University Community Clinical Oncology Program Research Base. Pre- and post-RT plasma hsCRP levels and Oncology Nursing Society skin toxicity criteria (0 to 6) were used to assess RT-induced skin toxicities. Multivariable logistic regression analyses were applied to ascertain the associations between hsCRP and RT-induced skin toxicities after adjusting for potential confounders. Results The study comprised 623 white, 280 African American, 64 Asian/Pacific Islander, and 33 other race patients; 24{\%} of the patients were Hispanic, and 47{\%} were obese. Approximately 42{\%} and 15{\%} of patients developed RT-induced grade 3+ and 4+ skin toxicities, respectively. The hsCRP levels differed significantly by race and body mass index but not by ethnicity. In multivariable analysis, grade 4+ skin toxicity was significantly associated with obesity (odds ratio [OR], 2.17; 95{\%} CI, 1.41 to 3.34], post-RT hsCRP $ 4.11 mg/L (OR, 1.61; 95{\%} CI, 1.07 to 2.44), and both factors combined (OR, 3.65; 95{\%} CI, 2.18 to 6.14). Above-median post-RT hsCRP (OR, 1.93; 95{\%} CI, 1.03 to 3.63), and change in hsCRP (OR, 2.80; 95{\%} CI, 1.42 to 5.54) were significantly associated with grade 4+ skin toxicity in nonobese patients. Conclusion This large prospective study is the first to our knowledge of hsCRP as an inflammatory biomarker in RT-induced skin toxicities in breast cancer. We demonstrate that nonobese patients with elevated RT-related change in hsCRP levels have a significantly increased risk of grade 4+ skin toxicity. The outcomes may help to predict RT responses and guide decision making.",
author = "Jennifer Hu and Urbanic, {James J.} and {Doug Case}, L. and Cristiane Takita and Wright, {Jean L.} and Brown, {Doris R.} and Langefeld, {Carl D.} and Lively, {Mark O.} and Mitchell, {Sandra E.} and Anu Thakrar and David Bryant and Kathy Baglan and Jon Strasser and Luis Baez-Diaz and Lesser, {Glenn J.} and Shaw, {Edward G.}",
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T1 - Association between inflammatory biomarker C-reactive protein and radiotherapy-induced early adverse skin reactions in a multiracial/ethnic breast cancer population

AU - Hu, Jennifer

AU - Urbanic, James J.

AU - Doug Case, L.

AU - Takita, Cristiane

AU - Wright, Jean L.

AU - Brown, Doris R.

AU - Langefeld, Carl D.

AU - Lively, Mark O.

AU - Mitchell, Sandra E.

AU - Thakrar, Anu

AU - Bryant, David

AU - Baglan, Kathy

AU - Strasser, Jon

AU - Baez-Diaz, Luis

AU - Lesser, Glenn J.

AU - Shaw, Edward G.

PY - 2018/8/20

Y1 - 2018/8/20

N2 - Purpose This study examined an inflammatory biomarker, high-sensitivity C-reactive protein (hsCRP), in radiotherapy (RT)-induced early adverse skin reactions or toxicities in breast cancer. Patients and Methods Between 2011 and 2013, 1,000 patients with breast cancer who underwent RT were evaluated prospectively for skin toxicities through the National Cancer Institute–funded Wake Forest University Community Clinical Oncology Program Research Base. Pre- and post-RT plasma hsCRP levels and Oncology Nursing Society skin toxicity criteria (0 to 6) were used to assess RT-induced skin toxicities. Multivariable logistic regression analyses were applied to ascertain the associations between hsCRP and RT-induced skin toxicities after adjusting for potential confounders. Results The study comprised 623 white, 280 African American, 64 Asian/Pacific Islander, and 33 other race patients; 24% of the patients were Hispanic, and 47% were obese. Approximately 42% and 15% of patients developed RT-induced grade 3+ and 4+ skin toxicities, respectively. The hsCRP levels differed significantly by race and body mass index but not by ethnicity. In multivariable analysis, grade 4+ skin toxicity was significantly associated with obesity (odds ratio [OR], 2.17; 95% CI, 1.41 to 3.34], post-RT hsCRP $ 4.11 mg/L (OR, 1.61; 95% CI, 1.07 to 2.44), and both factors combined (OR, 3.65; 95% CI, 2.18 to 6.14). Above-median post-RT hsCRP (OR, 1.93; 95% CI, 1.03 to 3.63), and change in hsCRP (OR, 2.80; 95% CI, 1.42 to 5.54) were significantly associated with grade 4+ skin toxicity in nonobese patients. Conclusion This large prospective study is the first to our knowledge of hsCRP as an inflammatory biomarker in RT-induced skin toxicities in breast cancer. We demonstrate that nonobese patients with elevated RT-related change in hsCRP levels have a significantly increased risk of grade 4+ skin toxicity. The outcomes may help to predict RT responses and guide decision making.

AB - Purpose This study examined an inflammatory biomarker, high-sensitivity C-reactive protein (hsCRP), in radiotherapy (RT)-induced early adverse skin reactions or toxicities in breast cancer. Patients and Methods Between 2011 and 2013, 1,000 patients with breast cancer who underwent RT were evaluated prospectively for skin toxicities through the National Cancer Institute–funded Wake Forest University Community Clinical Oncology Program Research Base. Pre- and post-RT plasma hsCRP levels and Oncology Nursing Society skin toxicity criteria (0 to 6) were used to assess RT-induced skin toxicities. Multivariable logistic regression analyses were applied to ascertain the associations between hsCRP and RT-induced skin toxicities after adjusting for potential confounders. Results The study comprised 623 white, 280 African American, 64 Asian/Pacific Islander, and 33 other race patients; 24% of the patients were Hispanic, and 47% were obese. Approximately 42% and 15% of patients developed RT-induced grade 3+ and 4+ skin toxicities, respectively. The hsCRP levels differed significantly by race and body mass index but not by ethnicity. In multivariable analysis, grade 4+ skin toxicity was significantly associated with obesity (odds ratio [OR], 2.17; 95% CI, 1.41 to 3.34], post-RT hsCRP $ 4.11 mg/L (OR, 1.61; 95% CI, 1.07 to 2.44), and both factors combined (OR, 3.65; 95% CI, 2.18 to 6.14). Above-median post-RT hsCRP (OR, 1.93; 95% CI, 1.03 to 3.63), and change in hsCRP (OR, 2.80; 95% CI, 1.42 to 5.54) were significantly associated with grade 4+ skin toxicity in nonobese patients. Conclusion This large prospective study is the first to our knowledge of hsCRP as an inflammatory biomarker in RT-induced skin toxicities in breast cancer. We demonstrate that nonobese patients with elevated RT-related change in hsCRP levels have a significantly increased risk of grade 4+ skin toxicity. The outcomes may help to predict RT responses and guide decision making.

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