# C-Reactive Protein Pretreatment-Level Evaluation with Histopathological Correlation for Chondrosarcoma Prognosis Assessment—A 15-Year Retrospective Single-Center Study

## TL;DR

This study shows that high pre-treatment C-reactive protein levels are linked to worse outcomes in chondrosarcoma patients.

## Contribution

The study identifies CRP as a novel prognostic marker for chondrosarcoma, linking it to metastasis risk.

## Key findings

- CRP levels above 0.5 mg/dL were associated with a 2.25 times higher risk of reduced follow-up time.
- Tumor size greater than pT2 was linked to a 3 times higher risk of reduced prognosis.
- High-grade tumors, elevated CRP, and tumor size >8 cm were confirmed as risk factors for poor outcomes.

## Abstract

Background: An aberrant cellular microenvironment characterized by pathological cells or inflammation represents an added risk factor across various cancer types. While the significance of chronic inflammation in the development of most diffuse tumors has been extensively studied, an exception to this analysis exists in the context of chondrosarcomas. Chondrosarcomas account for 20–30% of all bone sarcomas, with an estimated global incidence of 1 in 100,000. The average age at diagnosis is 50, and over 70% of patients are over 40. This retrospective study aimed to examine the role of C-reactive protein (CRP) as a prognostic factor in relation to the histopathological findings in chondrosarcoma. Methods: In this retrospective study, 70 patients diagnosed with chondrosarcoma and treated between 2004 and 2019 were included. Preoperative CRP levels were measured in mg/dL, with non-pathological values defined as below 0.5 mg/dL. Disease-free survival time was calculated from the initial diagnosis to events such as local recurrence or metastasis. Follow-up status was categorized as death from disease, no evidence of disease, or alive with disease. Patients were excluded if they had insufficient laboratory values, missing follow-up information, or incomplete histopathological reports. Results: The calculated risk estimation of a reduced follow-up time was 2.25 timed higher in the patients with a CRP level >0.5 mg/dL (HR 2.25 and 95% CI 1.13–4.45) and 3 times higher in patients with a tumor size > pT2 (HR 3 and 95% CI 1.59–5.92). We can easily confirm that risk factors for reduced prognosis lie in chondrosarcoma high grading, preoperative pathological CRP- level, and a size > 8 cm. Conclusions: A pretreatment CRP value greater than 0.5 mg/dL can be considered a sensitive prognostic and risk factor for distant metastasis for chondrosarcoma patients.