Prognostic impact of postoperative C-reactive protein level in patients with metastatic renal cell carcinoma undergoing cytoreductive nephrectomy.
OBJECTIVE
We explored the prognostic impact of C-reactive protein status in patients with metastatic renal cell carcinoma undergoing cytoreductive nephrectomy.


METHODS
The oncological outcome of 40 patients with metastatic renal cell carcinoma (TxpN1M0, TxNxM1) who underwent cytoreductive nephrectomy was analyzed. The C-reactive protein level was measured before and 1 month after cytoreductive nephrectomy. The normal value of C-reactive protein was considered less than 0.5 mg/dl.


RESULTS
During the median followup of 14 months 31 patients (78%) died of the disease. The preoperative C-reactive protein level was not increased in 17 of the 40 patients (nonelevated group). Of the remaining 23 patients with a preoperatively increased C-reactive protein level, after cytoreductive nephrectomy the C-reactive protein level normalized in 17 (normalized group). However, in the remaining 6 patients the C-reactive protein level did not normalize and remained high during followup (nonnormalized group). All of the patients in nonnormalized group died of the disease within 1 year. The overall survival rate of the nonnormalized group was significantly worse than that of the other 2 groups (p <0.0001). No significant difference was found in terms of overall survival rate between the normalized and nonelevated groups (p = 0.22). Multivariate analysis demonstrated that nonnormalized C-reactive protein (p <0.0001), absence of metastatectomy (p = 0.005), poorer performance status (p = 0.006) and bone metastases (p = 0.023) were independent factors for predicting poorer overall survival.


CONCLUSIONS
The current study indicated that C-reactive protein kinetics would predict the clinical course of patients with metastatic renal cell carcinoma who underwent cytoreductive nephrectomy. Larger confirmatory studies would be warranted to validate the current results.
Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan.
Manabu
M
Tatokoro
Kazutaka
K
Saito
Yasumasa
Y
Iimura
Yasuhisa
Y
Fujii
Satoru
S
Kawakami
Kazunori
K
Kihara
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D002292:Carcinoma, Renal Cell / Q000097:blood / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000401:mortality; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D002097:C-Reactive Protein