832 IMPACT OF POSTOPERATIVE C-REACTIVE PROTEIN LEVEL ON RECURRENCE AND PROGNOSIS IN PATIENTS WITH N0M0 RENAL CELL CARCINOMA (RCC)

Abstract

You have accessJournal of UrologyKidney Cancer: Localized I1 Apr 2010832 IMPACT OF POSTOPERATIVE C-REACTIVE PROTEIN LEVEL ON RECURRENCE AND PROGNOSIS IN PATIENTS WITH N0M0 RENAL CELL CARCINOMA (RCC) Keiichi Ito, Hidehiko Yoshii, Kenji Kuroda, Akinori Sato, Junichi Asakuma, Akio Horiguchi, Makoto Sumitomo, and Tomohiko Asano Keiichi ItoKeiichi Ito More articles by this author , Hidehiko YoshiiHidehiko Yoshii More articles by this author , Kenji KurodaKenji Kuroda More articles by this author , Akinori SatoAkinori Sato More articles by this author , Junichi AsakumaJunichi Asakuma More articles by this author , Akio HoriguchiAkio Horiguchi More articles by this author , Makoto SumitomoMakoto Sumitomo More articles by this author , and Tomohiko AsanoTomohiko Asano More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1533AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Level of serum C-reactive protein (CRP), a marker of inflammatory reaction, may reflect biological activity of RCC. Preoperative CRP level (preCRP) has been demonstrated to be a strong predictor for prognosis in RCC patients. Also, postoperative CRP level (postCRP) reportedly predicts prognosis of patients with metastatic RCC. In the present study we evaluated the impact of postCRP on recurrence and prognosis in patients with N0M0 RCC. METHODS We reviewed 274 patients with N0M0 RCC who underwent radical nephrectomy and whose preCRP and postCRP were available. Preoperative CRP elevation was defined as preCRP ≥1 ng/dl. Postoperative CRP normalization was defined as a decrease of postCRP to <0.3 ng/dl at least one time postoperatively. Clinicopathological factors including tumor grade, microvascular invasion (MVI), tumor necrosis, pathological T stage, thrombocytosis, anemia, lactate dehydrogenase and corrected calcium levels, and ECOG performance status (PS) were reviewed. Recurrence-free survival rates and overall survival rates were calculated by Kaplan-Meier method. To determine independent factors predicting recurrence and prognosis univariate and multivariate analyses were performed by using cox′s proportional hazards model. We also evaluated CRP levels at the time of recurrence and cause-specific survival after recurrence was compared between patients with CRP<0.3 and those with CRP≥0.3. RESULTS Thirty-nine of 274 patients had preoperative CRP elevation and in 13 patients postCRP were not normalized. Non-normalization of postCRP was associated with worse clinicopathological factors. By univariate and multivariate analyses, non-normalization of postCRP (p<0.0001), preCRP≥1 (p=0.0319), MVI (p=0.0008), tumor necrosis (p=0.0005), and PS (p=0.0375) were independent predictors for recurrence. Also, non-normalization of postCRP (p<0.0001), thrombocytosis (p=0.0072), and anemia (p=0.01) were independent predictors for overall survival. Fourty-six patients had recurrence at postoperative follow-up. At recurrence 22 of the 46 patients had CRP≥0.3 and 14 of the 22 patients (63.6%) had preoperative CRP elevation. Patients with CRP≥0.3 at recurrence had significantly lower survival rates than those with CRP<0.3 did (p=0.0076, 49.9 vs 81.4% at 3 years). CONCLUSIONS Non-normalization of postCRP is a strong predictor for recurrence and prognosis in patients with N0M0 RCC. Patients with CRP≥0.3 at the time of recurrence may indicate shorter survival period than those with CRP<0.3. Saitama, Japan© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e325 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Keiichi Ito More articles by this author Hidehiko Yoshii More articles by this author Kenji Kuroda More articles by this author Akinori Sato More articles by this author Junichi Asakuma More articles by this author Akio Horiguchi More articles by this author Makoto Sumitomo More articles by this author Tomohiko Asano More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...