Validation of serum C‐reactive protein (CRP) as an independent prognostic factor for disease‐free survival in patients with localised renal cell carcinoma (RCC)

Abstract

Objective• To validate high-sensitivity C-reactive protein (hs-CRP) serum levels as an independent marker for disease-free survival (DFS) in clinically localised clear cell renal cell carcinoma (ccRCC). Patients and Methods• In all, 403 consecutive patients with clinically localised (T1-3N0M0) ccRCC treated by radical or partial nephrectomy were enrolled.• Preoperative serum levels of hs-CRP were evaluated as both a continuous and categorical variables.• Associations with clinical (age, gender) and pathological variables (T classification, grade, tumour necrosis) were assessed with the chi-square and Kruskal-Wallis tests.• Univariable and multivariable Cox proportional hazards models were fitted. The prognostic accuracy (PA) was assessed with Harrell's C-index. Results• The mean hs-CRP level was 1.32 mg/dL. The hs-CRP levels were associated with T classification (P = 0.05), high-grade disease (P < 0.001) and tumour necrosis (P = 0.003).• After a median follow-up of 43 months, 41 patients (10.1%) had developed disease recurrence. With each unit increase in hs-CRP levels, the risk of recurrence increased by 10% (hazard ratio 1.10, P = 0.015).• The thresholds of 0.5 and 0.75 mg/dL showed the best discrimination for stratification of patients according to the probability of recurrence.• These categorically coded hs-CRP levels were identified as independent prognostic factors in multivariable analyses (P < 0.001) and led to a significant increase in the PA of a multivariable base model containing the variables of the 'Stage, Size, Grade and Necrosis' (SSIGN) score. Conclusions• This study validates preoperative serum hs-CRP levels as independent prognostic factor after surgery for localised ccRCC.• Hs-CRP may be included in standard prognostic modelling after surgery and may guide surveillance and inclusion in adjuvant clinical trials.

Neutrophil-lymphocyte ratio in small renal masses.

“…Numerous serum inflammation markers, such as CRP [6][7][8][9][10], have proven to be good prognostic indicators in patients with a variety of malignancies, but they require separate laboratory testing. The easily calculated NLR, on the other hand, has shown utility as an alternative marker of systemic inflammation in critically ill patients [19], malignancies [20], and chronic medical conditions such as end-stage renal disease and diabetes [21][22][23].…”

“…There is now an ample body of literature on the association between chronic inflammation and cancer [1][2][3][4], with an estimated 15% of malignancies worldwide being reported as having an infectious association or etiology [5]. C-reactive protein (CRP), a serum marker for systemic inflammation, has shown good prognostication in patients with renal cell carcinoma (RCC) [6][7][8][9][10] and similar findings when combined with serum albumin levels in the modified Glasgow Prognostic Score [3]. However, CRP requires additional serum testing and hence is not readily available for all patients.…”

C-Reactive Protein as a Prognostic Factor for Human Osteosarcoma: A Meta-Analysis and Literature Review

“…The prognostic significance of serum CRP was found in various cancer patients and in the advanced stage of cancers, including renal cell carcinoma [34], [35], [36], [37], [38], [39], [40], bladder [41], [42], [43], [44], breast [45], [46], [47], [48], [49], [50], stomach [51], , colon and rectum [56], , head and neck [62], [63], [64], esophagus [25], [65], [66], [67], [68], [69], prostate [70], [71], [72], [73], [74], lung [75], [76], [77], [78], [79] and pancreatic cancer [80], [81]. The high CRP levels have also been associated with aggressive diseases and poor survival outcomes for these malignancies.…”

Prognostic Significance of C-reactive Protein in Urological Cancers: a Systematic Review and Meta-analysis

“…A total of 43 eligible studies (7, 490 patients) were identified for this meta-analysis (25 for RCC (Atzpodien et al, 2003;Bromwich et al, 2004;Casamassima et al, 2005;Peccatori et al, 2005;Ito et al, 2006;Lamb et al, 2006;Vogl et al, 2006;Karakiewicz et al, 2007;Komai et al, 2007;Ramsey et al, 2007;Kawata et al, 2008;Ramsey et al, 2008;Tanaka et al, 2008;Iimura et al, 2009;Jagdev et al, 2010;Cho et al, 2011;Falkensammer et al, 2011;Bedke et al, 2012;Fujita et al, 2012;Sim et al, 2012;Steffens et al, 2012;de Martino et al, 2013;Yasuda et al, 2013), 10 for UC (Hilmy et al, 2005;Hilmy et al, 2006;Saito et al, 2007;Yoshida et al, 2008;Gakis et al, 2011;Saito and Kihara, 2011;Ishioka et al, 2012;Obata et al, 2012;Tanaka et al, 2012;Stein et al, 2013), and 8 for PC (McArdle et al, 2006;Beer et al, 2008;Nakashima et al, 2008;McArdle et al, 2010;Pond et al, 2012;Prins et al, ...…”