Inflammatory biomarker score and cancer: A population-based prospective cohort study

Abstract

Background: Inflammation is associated with cancer but there are conflicting reports on associations of biomarkers of inflammation with cancer risk and mortality. We investigated the associations of C-reactive protein (CRP) and leukocyte count with cancer risk and mortality using individual biomarkers, and an inflammatory score derived from both biomarkers. Methods: We conducted this analysis among 2,570 men enrolled in the population-based, prospective Kuopio Ischemic Heart Disease Risk Factor Study in Finland. During an average follow-up period of 26 years, 653 cancer cases and 287 cancer deaths occurred. We computed a z-score for each participant, with the combined z-score being the sum of each individual's CRP and leukocyte z-scores. Multivariable-adjusted Cox proportional hazard model was used to evaluate associations with cancer risk and mortality. Results: Using individual biomarkers, elevated leukocyte count was associated with an increased risk of cancer (RR = 1.31, 95 % CI 1.04-1.66), and cancer mortality (RR=, 95 % CI 1.39, 0.98-1.97). The corresponding results for CRP were (RR = 1.23, 95 % CI 0.97-1.55) for risk and (RR = 1.15, 95 % CI 0.81-1.64) for cancer mortality. Associations of the biomarkers with cancer appeared to be more robust using the combined z-score. HRs comparing men within the highest z-score quartile to those within the lowest z-score quartiles were 1.47 (95 % CI 1.16-1.88, p-trend < 0.01) for cancer risk, and 1.48 (95 % CI 1.03-2.14, p-trend = 0.09) for cancer mortality. Conclusion: Our study suggests that inflammation is associated with cancer risk and mortality, and combining inflammatory biomarkers into a score is a robust method of elucidating this association.