Prospective study of the relationship between the systemic inflammatory response, prognostic scoring systems and relapse-free and cancer-specific survival in patients undergoing potentially curative resection for renal cancer.
OBJECTIVE
To examine the prognostic value of markers of systemic inflammatory response, together with established scoring systems, in predicting relapse-free and cancer-specific survival in patients with primary operable renal cancer, as there is increasing evidence that such markers provide prognostic information, in addition to scoring systems, in patients with metastatic renal cancer.


METHODS
In all, 83 patients undergoing potentially curative nephrectomy for localized renal cancer were recruited. The University of California Los Angeles Integrated Staging System (UISS), 'Stage Size Grade Necrosis' (SSIGN) and Kattan scores were constructed. The systemic inflammatory response was assessed by counting white cells, neutrophils, lymphocytes and platelets, and measuring albumin and C-reactive protein (CRP) concentrations.


RESULTS
On multivariate analysis of the significant individual covariates, T stage (hazard ratio 2.38, 95% confidence interval 1.06- 5.36, P = 0.037), necrosis (3.73, 1.26-11.05, P = 0.018) and CRP (4.31, 1.20-15.49, P = 0.025) were significant independent predictors of relapse-free survival. On multivariate analysis of significant scoring systems and CRP, only UISS (3.50, 1.66-7.40, P = 0.001), SSIGN (2.83, 1.19-6.72, P = 0.018) and CRP (4.14, 1.16-14.73, P = 0.028) were significant independent predictors of relapse-free survival.


CONCLUSIONS
Elevated circulating CRP levels appear to be better than other markers of the systemic inflammatory response, and independent of established scoring systems, in predicting relapse-free and cancer-specific survival in patients undergoing potentially curative nephrectomy for renal cancer.
Ramsey
Sara
S
Department of Urology, Gartnavel General Hospital, Glasgow, UK. sara_l_ramsey@ntlworld.com
Lamb
Gavin W A
GW
Aitchison
Michael
M
McMillan
Donald C
DC
D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D002292:Carcinoma, Renal Cell / Q000378:metabolism / Q000401:mortality / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000378:metabolism / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000401:mortality; D009393:Nephritis / Q000378:metabolism / Q000401:mortality; D011379:Prognosis; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications* / Q000378:metabolism
D002097:C-Reactive Protein