title: Association of abnormal preoperative laboratory values with survival after radical nephrectomy for clinically confined clear cell renal cell carcinoma.
abstract: OBJECTIVE
  To determine whether preoperative laboratory values are independently associated with death from clinically confined clear cell renal cell carcinoma (RCC) after radical nephrectomy.
  
  
  METHODS
  We identified 1707 patients with clinically confined (pNx/pN0, pM0), unilateral, sporadic clear cell RCC treated with radical nephrectomy between 1970 and 2002. Associations of abnormal preoperative laboratory values including hypercalcemia, anemia, elevated erythrocyte sedimentation rate (ESR), and elevated alkaline phosphatase with death from RCC were evaluated using Cox proportional hazards regression models, both univariately and multivariately by adjusting for known prognostic features of the 2002 primary tumor classification, tumor size, nuclear grade, and coagulative tumor necrosis.
  
  
  RESULTS
  At last follow-up, 1009 patients had died, including 425 who died from RCC at a median of 3.0 years after surgery (range, 0 to 26 years). Even after adjusting for known prognostic features, 9% of patients with preoperative hypercalcemia exhibited significantly increased likelihood of dying from RCC compared with patients with normal or lower levels of serum calcium (relative ration [RR] 1.64; P = 0.002). Similarly, preoperative anemia (35% of patients; RR 1.27; P = 0.026) and elevated ESR (44% of patients; RR 1.66; P = 0.003) portended an increased risk of death from RCC even after multivariate adjustment.
  
  
  CONCLUSIONS
  Abnormal preoperative laboratory values including hypercalcemia, anemia, and elevated ESR are independently associated with increased risk of cancer-specific death from clinically confined clear cell RCC. Consideration of these variables in future models may improve prognostic accuracy. We believe these factors should be routinely assessed and included in prospective studies of outcome in RCC patients.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Magera
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Leibovich
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.forename: Shomik
authors.initials: S
authors.lastname: Sengupta
authors.forename: John C
authors.initials: JC
authors.lastname: Cheville
authors.forename: Eugene D
authors.initials: ED
authors.lastname: Kwon
authors.forename: Michael L
authors.initials: ML
authors.lastname: Blute
mesh_terms: D002292:Carcinoma, Renal Cell / Q000097:blood* / Q000401:mortality* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood* / Q000401:mortality* / Q000601:surgery; D008297:Male; D009392:Nephrectomy; D011300:Preoperative Care; D011379:Prognosis; D015996:Survival Rate