升高的C-反应蛋白（CRP）与结直肠癌（CRC）的增加风险和恶劣预后相关，但这些关联是否具有因果性仍不清楚。本研究使用双样本门洛尼治随机化（MR）方法，研究CRP水平与CRC生存之间的潜在因果关系。从韩国基因组和流行病学研究中（n = 59,605），提取7个与Log2转化的CRP水平相关的单核苷酸多态性（SNP）作为CRP水平的工具变量。使用Aalen的加性风险模型评估遗传预测的CRP与CRC患者（n = 6,460）的CRC特异性和总体死亡率之间的关联。敏感性分析排除了与血液脂质配置文件相关的SNP。在8.5年的中位随访期间，在6,460名CRC患者中，有2,676名（41.4％）CRC患者死亡，其中1,622名（25.1％）是由CRC引起的。遗传预测的CRP与CRC患者的总体或CRC特异性死亡率没有显着相关。每个1000人年的风险差异（95％置信区间）对于每次CRP翻倍的总体和CRC特异性死亡率分别为-2.92（-14.05-8.21）和-0.76（-9.61-8.08）。这些关联在依据转移的亚组分析和排除可能的多效性SNP的敏感性分析中保持一致。我们的发现不支持遗传易感CRP水平在CRC生存中具有因果作用。

Elevated C-reactive protein (CRP) is associated with an increased risk for, and poor prognosis of, colorectal cancer (CRC), but it remains unclear whether these associations are causal. This study examined potential causality between CRP levels and CRC survival using two-sample Mendelian randomization (MR).From the Korean Genome and Epidemiology Study, a genome-wide association study (n = 59,605), 7 single nucleotide polymorphisms (SNPs) related to log2-transformed CRP levels were extracted as instrumental variables for CRP levels. The associations between the genetically predicted CRP and CRC-specific and overall mortality among CRC patients (n=6,460) were evaluated by Aalen's additive hazard model. The sensitivity analysis excluded the SNP related to the blood lipid profile.During a median of 8.5 years of follow-up, among 6,460 CRC patients, 2,676 (41.4%) CRC patients died, 1,622 (25.1%) from CRC. Genetically predicted CRP was not significantly associated with the overall or CRC-specific mortality in CRC patients. The hazard difference per 1,000 person-year (95% confidence interval) for overall and CRC-specific mortality per two-fold increase in CRP was -2.92 (-14.05-8.21) and -0.76 (-9.61-8.08), respectively. These associations were consistent in subgroup analysis according to metastasis and sensitivity analysis excluding the possible pleiotropic SNP.Our findings do not support causal roles for genetically predisposed CRP levels in CRC survival.