C-reactive protein prior to cystectomy: An external validation of the TNR-C score.

Abstract

344 Background: Systemic inflammation has been described as a common reaction to cancer progression. Besides other malignancies, elevated serum CRP levels have been sparsely reported in bladder cancer patients prior to treatment. The aim of this study was to analyze whether our patient cohort showed association of CRP levels and survival after radical cystectomy as well as for external validation of the recently described TNR-C score. Methods: We retrospectively reviewed charts of patients undergoing radical cystectomy and bilateral pelvic lymphadenectomy between 1996 and 2005 identifying 279 patients of which 194 had preoperative CRP levels and no concomitant infection. CRP levels were defined as elevated if they were >5 mg/l. Cancer-specific outcome was predicted based on the aforementioned CRP-based scoring model (T=T-stage; N=N-stage; R=residual tumor; C=CRP). The mean follow-up was 29 months (0-131). Results: Elevated serum CRP levels were found in 89 (45.9%) patients preoperatively. These patients were more likely to have advanced tumor stages (pT3-4; p<0.01), positive resection margins (p<0.01) and positive lymph nodes (p<0.05). Cancer specific survival was decreased by approx. 17% after 12, 36, and 60 months. In multivariate analysis, CRP was identified as an independent prognostic indicator for poor cancer-specific survival. The 3-year CSS in patients with a TNR-score in the ranges 0-2, 3-6, and 7-10 was 74.0%, 33.3%, and 4.0%, respectively (p<0.001) with a concordance index of 0,833 (p<0.001). Conclusions: Elevated preoperative CRP levels might be used in nomograms to predict poor survival after radical cystectomy. The prognostic impact of the TNR-C score could be validated. However, more evidence, especially from prospective studies is needed.