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Systemic inflammation is increased in obesity. We examined the association between C-reactive protein (CRP) and disease-free survival (DFS) and overall survival (OS) overall, and according to body mass index (BMI). We assembled a cohort of women with BC (stage I\u2013III) seen at Aarhus University Hospital between 2010 and 2020 who donated blood at BC diagnosis (N\u2009=\u20092673). CRP levels were measured and divided into quartiles. We followed patients from surgery to recurrence, contralateral BC, other malignancy, death, emigration, or end-of-follow-up. We used Cox regression to estimate hazard ratios (HRs) with 95% confidence intervals (95% CIs) to compare outcomes across CRP quartiles, overall and stratified by BMI (normal-weight (18.5\u2009\u2264\u2009BMI\u2009&lt;\u200925\u00a0kg\/m\n                    <jats:sup>2<\/jats:sup>\n                    ), overweight (25\u2009\u2264\u2009BMI\u2009&lt;\u200930\u00a0kg\/m\n                    <jats:sup>2<\/jats:sup>\n                    ), and obesity (BMI\u2009\u2265\u200930\u00a0kg\/m\n                    <jats:sup>2<\/jats:sup>\n                    )). During follow-up, 368 events (212 recurrences, 38 contralateral BCs, and 118 deaths) occurred (median follow-up 5.55 years). For DFS, high CRP (CRP\u2009\u2265\u20093.19\u00a0mg\/L) was associated with an increased risk of events (HR\n                    <jats:sub>adj<\/jats:sub>\n                    :1.62 [95% CI\u2009=\u20091.14\u20132.28]). In BMI-stratified analyses, high CRP was associated with elevated risk of events in normal-weight and overweight (HR\n                    <jats:sub>adj<\/jats:sub>\n                    :1.70 [95% CI\u2009=\u20091.09\u20132.66]; HR\n                    <jats:sub>adj<\/jats:sub>\n                    :1.75 [95% CI\u2009=\u20091.08\u20132.86]), but in obesity, the estimate was less precise (HR\n                    <jats:sub>adj<\/jats:sub>\n                    :1.73 [95% CI\u2009=\u20090.78\u20133.83]). For OS, high CRP was associated with increased risk of death (HR\n                    <jats:sub>adj<\/jats:sub>\n                    :2.47 [95% CI\u2009=\u20091.62\u20133.76]). The association was strong in normal-weight and overweight (HR\n                    <jats:sub>adj<\/jats:sub>\n                    :3.66 [95% CI\u2009=\u20091.95\u20136.87]; HR\n                    <jats:sub>adj<\/jats:sub>\n                    :1.92 [95% CI\u2009=\u20091.06\u20133.46]), but less clear in obesity (HR\n                    <jats:sub>adj<\/jats:sub>\n                    :1.40 [95% CI\u2009=\u20090.64\u20133.09]). To sum up,\u00a0high CRP levels at BC diagnosis were associated with inferior prognosis in early BC irrespective of BMI, although less clear in patients with obesity.\n                  <\/jats:p>","DOI":"10.1038\/s41598-024-64428-3","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T07:03:19Z","timestamp":1719212599000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Circulating C-reactive protein levels as a prognostic biomarker in breast cancer across body mass index groups"],"prefix":"10.1038","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6004-0104","authenticated-orcid":false,"given":"J. 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