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Perioperative trajectories of acute-phase proteins and their association with major postoperative complications in advanced ovarian cancer

Daniel, Hunde ; Groes-Kofoed, Nina ; Ul Hassan, Mahmood ; Wedin, Madelene ; Kannisto, Päivi LU ; Asp, Mihaela LU orcid and Salehi, Sahar (2026) In European Journal of Surgical Oncology p.1-9
Abstract
Background
Acute-phase proteins (APPs) reflect systemic inflammation and nutritional status, yet their perioperative trajectories and clinical utility as biomarkers of outcome in advanced ovarian cancer (aEOC) remain unclear. We aimed to characterise perioperative APP fluctuations and assess their associations with postoperative complications.
Methods
This observational study included patients undergoing cytoreductive surgery for aEOC across two prospective studies (n = 274). Serial serum albumin, transthyretin, C-reactive protein (CRP), fibrinogen, and procalcitonin were measured preoperatively and on postoperative days (PoD) 1, 3, and 5. Associations between APP levels and major postoperative complications, classified by... (More)
Background
Acute-phase proteins (APPs) reflect systemic inflammation and nutritional status, yet their perioperative trajectories and clinical utility as biomarkers of outcome in advanced ovarian cancer (aEOC) remain unclear. We aimed to characterise perioperative APP fluctuations and assess their associations with postoperative complications.
Methods
This observational study included patients undergoing cytoreductive surgery for aEOC across two prospective studies (n = 274). Serial serum albumin, transthyretin, C-reactive protein (CRP), fibrinogen, and procalcitonin were measured preoperatively and on postoperative days (PoD) 1, 3, and 5. Associations between APP levels and major postoperative complications, classified by Clavien–Dindo (CD ≥ III), were examined using multivariable logistic regression. Length of stay (LOS) was evaluated for biomarkers showing significant associations. Predictive thresholds were derived by ROC analysis.
Results
Positive APPs peaked postoperatively (CRP and fibrinogen on PoD 3; procalcitonin on PoD 1), while negative APPs reached nadirs on PoD 3. Neither preoperative albumin (>35 g/L) nor transthyretin (>0.2 g/L) predicted major postoperative complications. In contrast, elevated CRP measured on PoD 3 was associated with both major postoperative complications, OR 2.78 (95% CI 1.45–5.48) and prolonged LOS (>7 days) OR 3.0 (95% CI 1.67–5.47), with optimal cut-offs of ≥287 mg/L and ≥322 mg/L respectively (AUC 0.80).
Conclusion
Preoperative APPs were not associated with postoperative outcomes in this cohort. CRP measured on postoperative day 3 was the most informative biomarker associated with major postoperative complications and prolonged hospital stay after cytoreductive surgery for advanced ovarian cancer and may support postoperative surveillance and recovery assessment when interpreted alongside clinical findings. (Less)
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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Surgical Oncology
article number
111509
pages
1 - 9
publisher
Elsevier
external identifiers
  • scopus:105034592896
  • pmid:41774978
ISSN
1532-2157
DOI
10.1016/j.ejso.2026.111509
language
English
LU publication?
yes
id
6023374e-47b4-40be-ab16-c3627ebb0242
date added to LUP
2026-03-02 15:37:00
date last changed
2026-06-02 03:00:23
@article{6023374e-47b4-40be-ab16-c3627ebb0242,
  abstract     = {{Background<br/>Acute-phase proteins (APPs) reflect systemic inflammation and nutritional status, yet their perioperative trajectories and clinical utility as biomarkers of outcome in advanced ovarian cancer (aEOC) remain unclear. We aimed to characterise perioperative APP fluctuations and assess their associations with postoperative complications.<br/>Methods<br/>This observational study included patients undergoing cytoreductive surgery for aEOC across two prospective studies (n = 274). Serial serum albumin, transthyretin, C-reactive protein (CRP), fibrinogen, and procalcitonin were measured preoperatively and on postoperative days (PoD) 1, 3, and 5. Associations between APP levels and major postoperative complications, classified by Clavien–Dindo (CD ≥ III), were examined using multivariable logistic regression. Length of stay (LOS) was evaluated for biomarkers showing significant associations. Predictive thresholds were derived by ROC analysis.<br/>Results<br/>Positive APPs peaked postoperatively (CRP and fibrinogen on PoD 3; procalcitonin on PoD 1), while negative APPs reached nadirs on PoD 3. Neither preoperative albumin (&gt;35 g/L) nor transthyretin (&gt;0.2 g/L) predicted major postoperative complications. In contrast, elevated CRP measured on PoD 3 was associated with both major postoperative complications, OR 2.78 (95% CI 1.45–5.48) and prolonged LOS (&gt;7 days) OR 3.0 (95% CI 1.67–5.47), with optimal cut-offs of ≥287 mg/L and ≥322 mg/L respectively (AUC 0.80).<br/>Conclusion<br/>Preoperative APPs were not associated with postoperative outcomes in this cohort. CRP measured on postoperative day 3 was the most informative biomarker associated with major postoperative complications and prolonged hospital stay after cytoreductive surgery for advanced ovarian cancer and may support postoperative surveillance and recovery assessment when interpreted alongside clinical findings.}},
  author       = {{Daniel, Hunde and Groes-Kofoed, Nina and Ul Hassan, Mahmood and Wedin, Madelene and Kannisto, Päivi and Asp, Mihaela and Salehi, Sahar}},
  issn         = {{1532-2157}},
  language     = {{eng}},
  month        = {{02}},
  pages        = {{1--9}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Surgical Oncology}},
  title        = {{Perioperative trajectories of acute-phase proteins and their association with major postoperative complications in advanced ovarian cancer}},
  url          = {{http://dx.doi.org/10.1016/j.ejso.2026.111509}},
  doi          = {{10.1016/j.ejso.2026.111509}},
  year         = {{2026}},
}