Prognostic Impact of Postoperative C-Reactive Protein Level in Patients With Metastatic Renal Cell Carcinoma Undergoing Cytoreductive Nephrectomy

Tatokoro, Manabu; Saito, Kazutaka; Iimura, Yasumasa; Fujii, Yasuhisa; Kawakami, Satoru; Kihara, Kazunori

doi:10.1016/j.juro.2008.04.025

Cited by 58 publications

(32 citation statements)

References 18 publications

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“…48 We showed that perioperative dynamic changes in CRP concentration, CRP kinetics, predicted the clinical course of metastatic RCC patients treated with cytoreductive nephrectomy. 50 In this study, patients were divided into three groups based on their preoperative CRP levels and the status of CRP normalization 1 month after the operation. Patients whose preoperative CRP was not elevated (CRP <5 mg/L) were assigned to the non-elevated CRP group.…”

Section: Crp Kinetics In Renal Cell Carcinomamentioning

confidence: 99%

Role of C‐reactive protein in urological cancers: A useful biomarker for predicting outcomes

Saito

Kihara

2012

Int J of Urology

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Abbreviations & AcronymsAbstract: Based on increasing evidence of the association between cancer-related inflammation and the progression of cancer, the external symptoms of systemic inflammatory response has been shown to be an indicator for the prognosis of many malignancies, including urological cancers. C-reactive protein, a representative acute-phase reactant, is a significant and sensitive inflammatory marker that can be objectively measured using reliable assays in clinical practice worldwide. C-reactive protein has been shown to be significant in the prediction of outcomes of urological cancers. The elevation of C-reactive protein levels, which indicate the presence of cancer-associated systemic inflammatory response, is linked to poorer survival in patients with urological cancers, including renal cell carcinoma, upper urinary tract and bladder cancers, and prostate cancer. With this strong prognostic ability, C-reactive protein can be incorporated into prognostic models and will make them simpler and improve their predictive accuracy. Furthermore, the longitudinal change of C-reactive protein level, C-reactive protein kinetics, provides additional information on patient survival outcomes. As such, C-reactive protein can be used to monitor treatment efficacy and disease course using serial measurements. In testicular cancer, C-reactive protein is associated with a risk of late complications, such as cardiovascular disease, and with the development of second non-germ-cell cancer. Taken together, these findings show that C-reactive protein can act as an important biomarker for urological cancers. This review discusses the importance of C-reactive protein as a prognostic biomarker in urological cancers on the basis of the currently available evidence.

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Section: Crp Kinetics In Renal Cell Carcinomamentioning

confidence: 99%

Role of C‐reactive protein in urological cancers: A useful biomarker for predicting outcomes

Saito

Kihara

2012

Int J of Urology

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“…Patients whose postoperative nadir CRP decreased to within normal limits (<1.0 ng/ml) exhibited significantly better disease-specific survival compared with patients whose CRP remained elevated (P=0.0025) (13). Subsequently, Tatokoro et al (14) reported that the prognosis of patients whose CRP normalized (to <0.5 mg/dl) following cytoreductive nephrectomy and the prognosis of patients without preoperative elevated CRP were better compared with the prognosis of patients whose CRP did not normalize after surgery. These investigators concluded that CRP kinetics may predict the clinical course of patients with metastatic RCC who undergo cytoreductive nephrectomy (14).…”

Section: Discussionmentioning

confidence: 98%

“…Subsequently, Tatokoro et al (14) reported that the prognosis of patients whose CRP normalized (to <0.5 mg/dl) following cytoreductive nephrectomy and the prognosis of patients without preoperative elevated CRP were better compared with the prognosis of patients whose CRP did not normalize after surgery. These investigators concluded that CRP kinetics may predict the clinical course of patients with metastatic RCC who undergo cytoreductive nephrectomy (14). Saito et al (15) reported that CRP kinetics affect survival in patients with metastatic RCC treated with immunotherapy, metastasectomy, or both.…”

Section: Discussionmentioning

confidence: 99%

“…For example, Tatokoro et al (14) reported that CRP decreased to normal after cytoreductive nephrectomy in 74% of patients who had elevated CRP prior to surgery, and Ito et al (16) reported that 65.8% of patients achieved CRP normalization following nephrectomy. By contrast, Saito et al (15) reported that, among patients who underwent immunotherapy, metastasectomy, or both, only 49% achieved CRP normalization.…”

Section: Discussionmentioning

confidence: 99%

“…However, the prognostic role of CRP kinetics after sunitinib initiation has not been investigated to date. Previous studies have demonstrated that postoperative normalization of the CRP level is associated with better prognosis in patients with localized or advanced RCC who receive nephrectomy, metastasectomy, or both (13)(14)(15)(16). In addition, CRP kinetics has been found to be a prognostic factor for the effect of cytokine therapies (13,15,17).…”

Section: Introductionmentioning

confidence: 99%

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Prognostic effect of serum C-reactive protein kinetics on advanced renal cell carcinoma treated with sunitinib

Fujita

Tabata

Ishii

et al. 2017

Molecular and Clinical Oncology

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Abstract. C-reactive protein (CRP) is an independent prognostic factor for renal cell carcinoma (RCC). The aim of the present study was to investigate the prognostic effect of pretreatment serum CRP level and CRP kinetics on patients with advanced RCC treated with sunitinib. A total of 56 consecutive patients with advanced RCC treated with sunitinib between December, 2008 and December, 2012 were enrolled in the present study. The patients were retrospectively divided into 3 cohorts according to pretreatment serum CRP level and CRP kinetics: i) Normal CRP cohort (pretreatment CRP ≤0.30 mg/dl); ii) normalized CRP cohort (pretreatment CRP >0.30 mg/dl that normalized within 2 cycles of treatment); and iii) non-normalized CRP cohort (pretreatment CRP >0.30 mg/dl that did not normalize after sunitinib initiation). Disease control rate, progression-free survival and overall survival times were compared for the 3 cohorts. The normal (n=17, 30.4%) and the normalized (n=8, 14.3%) CRP cohorts exhibited significantly better disease control rates compared with the non-normalized CRP cohort (n=31, 55.4%; P<0.0001 and P=0.0445, respectively). The normal CRP cohort exhibited significantly longer progression-free survival compared with the non-normalized CRP cohort (P=0.0050). The normal and normalized CRP cohorts exhibited significantly longer overall survival compared with the non-normalized CRP cohort (P=0.0005 and 0.0466, respectively). Therefore, CRP kinetics and normal pretreatment CRP level are prognostic indicators in patients with advanced RCC treated with sunitinib. IntroductionC-reactive protein (CRP), which was found to be a representative acute-phase reactant in 1930, is the most widely used marker of systemic inflammation (1). Inflammation plays an important role during almost all stages of tumor development (2). For example, the proliferation of renal cell carcinoma (RCC) is associated with increased levels of interleukin-6 (IL-6), nuclear factor-κB, and other inflammatory factors (3,4), and the serum CRP levels were found to be correlated with the levels of proinflammatory cytokines, such as IL-6 (5). Numerous studies have demonstrated that CRP is a significant prognostic factor among patients with RCC at various stages, whether they are being treated by surgery, systemic therapy, or both (6).Sunitinib malate (Sutent, Pfizer Inc., New York, NY, USA) is an orally administered, small-molecule, multitargeted inhibitor of tyrosine kinases (e.g., vascular endothelial growth factor receptor, platelet-derived growth factor receptor, phosphorylation of stem cell factor receptor, Fms-like tyrosine kinase-3, colony-stimulating factor-1 receptor, and RET receptor tyrosine kinases). In a phase III clinical trial including patients with advanced RCC, sunitinib achieved significantly better results compared with interferon (IFN)-α and is approved worldwide for the treatment of advanced RCC (7,8). The number of patients treated with sunitinib is increasing and, therefore, there is an urgent need to identify biomarkers that may...

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Can we better select patients with metastatic renal cell carcinoma for cytoreductive nephrectomy?

Culp

Tannir

Abel

et al. 2010

Cancer

195

116

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BACKGROUND:The benefits of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) should outweigh surgical morbidity. Even when the generally agreed upon selection criteria for CN are met, some patients do poorly after surgery. The objective of this study was to identify preoperative factors that were prognostic of outcome in patients who were being considered for CN. METHODS: The authors conducted a retrospective study to investigate the overall survival (OS) of patients who underwent CN using the OS of patients with mRCC who did not undergo CN as a referent group. Patients who underwent CN were divided into 2 groups based on when their OS diverged from that of nonsurgical patients. Chi-square analysis was used to identify variables that differed between the 2 surgical groups. Multivariate Cox proportional hazards regression was used to analyze those variables for the entire CN cohort. Risk factors were defined as preoperative variables that remained significant on multivariate analysis. The median OS and the overall risk of death were calculated based on the number of risk factors. RESULTS: From 1991 to 2007, 566 patients who were eligible for or received systemic therapy underwent CN, and 110 patients received medical therapy alone. On multivariate analysis, independent preoperative predictors of inferior OS in surgical patients included a lactate dehydrogenase level greater than the upper limit of normal, an albumin level less than the lower limit of normal, symptoms at presentation caused by a metastatic site, liver metastasis, retroperitoneal adenopathy, supradiaphragmatic adenopathy, and clinical tumor classification !T3. Inferior OS and an increased risk of death were correlated positively with the number of risk factors. Surgical patients who had !4 risk factors did not appear to benefit from CN. CONCLUSIONS: The authors of this report identified 7 preoperative variables that permitted them to identify patients who were unlikely to benefit from CN. Cancer 2010;116:3378-88.

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Prognostic Impact of Postoperative C-Reactive Protein Level in Patients With Metastatic Renal Cell Carcinoma Undergoing Cytoreductive Nephrectomy

Abstract: The current study indicated that C-reactive protein kinetics would predict the clinical course of patients with metastatic renal cell carcinoma who underwent cytoreductive nephrectomy. Larger confirmatory studies would be warranted to validate the current results.

Cited by 58 publications

References 18 publications

Role of C‐reactive protein in urological cancers: A useful biomarker for predicting outcomes

Role of C‐reactive protein in urological cancers: A useful biomarker for predicting outcomes

Prognostic effect of serum C-reactive protein kinetics on advanced renal cell carcinoma treated with sunitinib

Can we better select patients with metastatic renal cell carcinoma for cytoreductive nephrectomy?

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