Abstract
BackgroundTo evaluate the prognostic significance of the pre-operative C-reactive protein (CRP) serum level in patients with renal cell cancer (RCC).MethodsWe evaluated 1,161 RCC patients with complete patient and tumour specific characteristics as well as information about their pre-operative CRP-level, who had undergone either radical nephrectomy or nephron-sparing surgery at two German high-volume centres (University Hospitals of Hannover and Ulm). The mean follow-up was 54 months.ResultsThe CRP-level, stratified to three subgroups (CRP ≤ 4, 4–10, and >10 mg/l), correlated significantly with tumour stage (p < 0.001), the risk of presenting nodal disease (2.1, 3.1, and 16.4%) and distant metastasis (2.9, 8.6, and 30.0%; p < 0.001). The Kaplan-Meier 5-year cancer specific survival (CSS) rates were 89.4, 77.9, and 49.5%, respectively (p < 0.001). Multivariate analysis identified CRP as an independent prognosticator for CSS as well as overall survival (p < 0.001). Patients with a CRP of 4–10 and >10 mg/l had a 1.67 and 2.48 fold higher risk of dying due to their RCC compared to those with a pre-operative CRP ≤4 mg/l, respectively.ConclusionsA high preoperative serum CRP level is an independent predictor of poor survival in patients with RCC. Its routine use could allow better risk stratification and risk-adjusted follow-up of RCC patients.
Highlights
To evaluate the prognostic significance of the pre-operative C-reactive protein (CRP) serum level in patients with renal cell cancer (RCC)
More than 40,000 new cases of renal cell carcinoma (RCC) are diagnosed in the European Union every year and about half of these patients will eventually die from RCC [1]
Receiver operation characteristics (ROC) curves were constructed to assess the potential of preoperative CRP to predict overall and cancer-specific survival and to identify cut-offs to categorise CRP-levels in risk groups
Summary
To evaluate the prognostic significance of the pre-operative C-reactive protein (CRP) serum level in patients with renal cell cancer (RCC). Elevated CRP levels can be a result of an underlying cancer and a premalignant state, respectively, as well as due to tumour growth associated tissue inflammation. It is still unclear if the tumor promotes inflammation or if inflammation promotes tumor aggressiveness. Experimental studies showed that at least some renal tumours produce interleukin-6, which promotes growth of RCC and the presence of systemic inflammatory response could promote tumor aggressiveness [12,13]
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