Validation of serum C-reactive protein (CRP) as an independent prognostic factor for disease-free survival in patients with localised renal cell carcinoma (RCC)

被引：58

作者：

de Martino, Michela ^{[1
]}

Klatte, Tobias ^{[1
]}

Seemann, Christoph ^{[1
]}

Waldert, Matthias ^{[1
]}

Haitel, Andrea ^{[2
]}

Schatzl, Georg ^{[1
]}

Remzi, Mesut ^{[3
]}

Weibl, Peter ^{[1
]}

机构：

[1] Med Univ Vienna, Dept Urol, A-1090 Vienna, Austria

[2] Med Univ Vienna, Dept Clin Pathol, A-1090 Vienna, Austria

[3] LKH Weinviertel Korneuburg, Dept Urol, Korneuburg, Austria

来源：

BJU INTERNATIONAL | 2013年 / 111卷 / 08期

关键词：

CRP; inflammation; recurrence; accuracy; prognosis; kidney cancer;

D O I：

10.1111/bju.12067

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Objective To validate high-sensitivity C-reactive protein (hs-CRP) serum levels as an independent marker for disease-free survival (DFS) in clinically localised clear cell renal cell carcinoma (ccRCC). Patients and Methods In all, 403 consecutive patients with clinically localised (T1-3N0M0) ccRCC treated by radical or partial nephrectomy were enrolled. Preoperative serum levels of hs-CRP were evaluated as both a continuous and categorical variables. Associations with clinical (age, gender) and pathological variables (T classification, grade, tumour necrosis) were assessed with the chi-square and Kruskal-Wallis tests. Univariable and multivariable Cox proportional hazards models were fitted. The prognostic accuracy (PA) was assessed with Harrell's C-index. Results The mean hs-CRP level was 1.32mg/dL. The hs-CRP levels were associated with T classification (P = 0.05), high-grade disease (P < 0.001) and tumour necrosis (P = 0.003). After a median follow-up of 43 months, 41 patients (10.1%) had developed disease recurrence. With each unit increase in hs-CRP levels, the risk of recurrence increased by 10% (hazard ratio 1.10, P = 0.015). The thresholds of 0.5 and 0.75mg/dL showed the best discrimination for stratification of patients according to the probability of recurrence. These categorically coded hs-CRP levels were identified as independent prognostic factors in multivariable analyses (P < 0.001) and led to a significant increase in the PA of a multivariable base model containing the variables of the Stage, Size, Grade and Necrosis' (SSIGN) score. Conclusions This study validates preoperative serum hs-CRP levels as independent prognostic factor after surgery for localised ccRCC. Hs-CRP may be included in standard prognostic modelling after surgery and may guide surveillance and inclusion in adjuvant clinical trials.

引用

页码：E348 / E353

页数：6

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