Prognostic value of preoperative C-reactive protein /albumin ratio in patients with clear cell renal cell carcinoma

Abstract

Objective To assess the prognostic value of C-reactive protein/albumin (CRP/Alb) ratio in patients with clear cell renal cell carcinoma (ccRCC). Methods The study comprised 406 ccRCC patients undergoing nephrectomy between January 2003 and December 2012 in our hospital. There were 253 males and 153 females, aged 24-80 years, with a median age of 58 years. There were 355 cases with TNM Ⅰ stage, 38 cases with Ⅱ stage, 30 cases with Ⅲ stage, 3 cases with Ⅳ stage. There were 376 cases with tumor necrosis and 40 cases without tumor necrosis. There were 395 cases of vascular invasion, 21 cases without vessel invasion. The correlations among the pretreatment CRP/Alb ratio, clinicopathological parameters, and overall survival (OS) were evaluated. We compared the prognostic value of the CRP/Alb ratio with GPS and mGPS using the area under the curve (AUC). Results CRP/Alb ratio was associated with age at surgery (P=0.007), TNM stage (P<0.001), tumor necrosis (P<0.001) and lymphovascular invasion (P<0.001), and OS (P<0.001). The multivariate analysis confirmed that the CRP/Alb ratio independently predicted the OS of patients with ccRCC (P<0.001), the Glasgow prognostic score (GPS) (P=0.001) and modified GPS (mGPS) (P=0.019) were also independent prognostic factors. For predicting 3-year survival, the AUC values for CRP/Alb (continuous), CRP/Alb (categorical), GPS and mGPS were 0.88, 0.84, 0.85, 0.80. For predicting 5-year survival, the AUC values for CRP/Alb (continuous), CRP/Alb (categorical), GPS and mGPS were 0.80, 0.79, 0.76, 0.72. The CRP/Alb ratio was superior to GPS and mGPS in predicting the 3- or 5-year survival rate of ccRCC patients. Conclusions The CRP/Alb ratio could be an independent prognostic factor in ccRCC patients. The CRP/Alb ratio could take the place of the GPS and mGPS in terms of predicting prognosis in ccRCC. Key words: Clear cell renal cell carcinoma; C-reactive protein; Albumin; Prognosis