Level of preoperative CRP as an independent predictor of survival in patients after nephrectomy for renal cell carcinoma: Long-term outcomes.

Abstract

687 Background: Preoperative C- Reactive Protein (CRP) has predictive value for metastasis development and mortality in renal cell carcinoma (RCC). However, the predictive potential of preoperative CRP at presentation on survival after nephrectomy remains unclear. This study investigates the prognostic value of preoperative CRP on overall long term survival in RCC patients post-nephrectomy. Methods: 683 post-nephrectomy patients for localized clear cell RCC were evaluated from 2005-2017 to investigate preoperative CRP’s prognostic value on overall survival. Cohort was divided into 3 groups based on preoperative CRP (≤ 10, 10-100, > 100 mg/L). Kaplan-Meier curve and Cox proportional hazards models evaluated the predictive value of preoperative CRP in addition to established covariates. Results: Mean age was 59±12 years. 81 (11.6%) patients were deceased at the end of follow-up. T-stage distribution of cohort as follows: T1 = 444 (65%), T2 = 38 (6%), T3 = 197 (29%), and T4 = 4 (1%). Log Rank test of the Kaplan–Meier estimates of survival probability in RCC patients stratified by preoperative CRP revealed significant difference (p-value < 0.001). Per Cox models, high preoperative CRP values were associated with higher mortality (P < 0.001), higher T Stage (P < 0.001), Fuhrman Grade (P < 0.001), fat invasion (P < 0.001), and necrosis (P < 0.001). Multivariable model identified high preoperative CRP ( > 100) as an independent predictor of survival compared to low-to-normal (HR: 2.1, 95%CI: 1.00-4.23, p-value-0.05). 5-year survival of patients with CRP > 100 was 43%. Conclusions: Preoperative CRP could potentially be used as an independent predictor of overall survival post nephrectomy in patients with RCC. Higher CRP values are associated with higher mortality in such patients.