1637 - Combination of serum procalcitonin and C-reactive protein level as a diagnostic marker of discriminating infection from neoplastic fever in febrile...

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Supportive measures
Thoracic malignancies
Presenter Keisuke Miyamoto
Authors K. Miyamoto1, R. Seki2, D. Taniyama3, H. Kamata3, F. Sakamaki3
  • 1Pulmonary Medicine Dept., Saiseikai Central Hospital, 1080073 - Minato-ku, Tokyo/JP
  • 2Pathology, Saiseikai Central Hospital, Tokyo/JP
  • 3Pulmonary Medicine, Saiseikai Central Hospital, 1080073 - Minato-ku, Tokyo/JP



Neoplastic fever in lung cancer is assessed on clinical course only, and is difficult to discriminate from infection.


To evaluate the diagnostic role of procalcitonin (PCT) and C-reactive protein (CRP) in discriminating neoplastic fever and infection.


We reviewed the medical records of 112 consecutive febrile episodes of 52 patients (39 males, mean age 67.1y/o), who were diagnosed as lung cancer from November 2009 to April 2012 at our Saiseikai Central Hospital in Tokyo, Japan. Based on clinical, laboratory, and bacteriological results, patients were classified as having neoplastic fever (NF, n = 53), suspected or definite bacterial infection (BI, n = 59). Values of white blood cell count (WBC), PCT, and CRP were measured on day 1 of onset of fever. Microbiological specimen and radiological imaging study were also performed to diagnose infectious diseases or other febrile conditions.


The most common infection was pneumonia (38.4 %). Mean WBC (12000 vs. 14800) were not statistically significant. Mean values of PCT were significantly higher in patients with BI compared with NF (0.14 vs. 3.95 ng/ml, p < 0.05). Mean values of CRP were also significantly higher in patients with BI compared with NF (8.6 vs. 15.2 mg/dl, p < 0.05). Combination of CRP level at the threshold value of 10.2 mg/dl and PCT level at the threshold value of 0.32 ng/ml were the most sensitive from ROC curve for discriminating infection to neoplastic fever.


Combination of PCT and CRP on the day of onset of fever is useful in discriminating neoplastic fever from infection in febrile lung cancer patients.


All authors have declared no conflicts of interest.