title: The impact of preoperative serum C-reactive protein on the prognosis of patients with upper urinary tract urothelial carcinoma treated surgically.
abstract: OBJECTIVE
  To assess the impact of preoperative C-reactive protein (CRP) levels on the prognosis in patients with upper urinary tract (UUT) urothelial carcinoma (UC) primarily treated surgically, as it is increasingly recognized that a systemic inflammatory response is associated with the prognosis for patients with various malignancies.
  
  
  METHODS
  The clinical records of 130 patients treated surgically for UUT-UC were reviewed retrospectively. An elevated CRP was defined as >0.5 mg/dL. Actuarial survival curves were calculated by Kaplan-Meier method, with the difference between curves evaluated using the log-rank test. A multivariate analysis was used to identify prognostic factors, with Cox's proportional hazard model.
  
  
  RESULTS
  The median (range) follow-up was 47 (3-190) months. The preoperative serum CRP level was elevated in 24 patients (23%). There were significant associations between CRP level and haemoglobin concentrations, pathological T stage, tumour grade, lymph node involvement and lymphovascular invasion. The 5-year disease-specific and recurrence-free survival rates of 24 patients with elevated CRP were significantly worse than those of the 106 with no CRP elevation (both P < 0.001). On multivariate analysis, preoperative CRP level, pathological T stage and lymph node involvement were significant prognostic factors for disease-specific and recurrence-free survival.
  
  
  CONCLUSIONS
  This study indicated that an elevated preoperative CRP level predicts a poor survival in patients with UUT-UC.
authors.affiliation: Department of Urology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan. kz-saito.uro@tmd.ac.jp
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Saito
authors.forename: Satoru
authors.initials: S
authors.lastname: Kawakami
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Ohtsuka
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujii
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Masuda
authors.forename: Jiro
authors.initials: J
authors.lastname: Kumagai
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kageyama
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kihara
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019459:Urothelium / Q000473:pathology / Q000601:surgery
chemical_list: D002097:C-Reactive Protein