title: Postoperative better than preoperative C-reactive protein at predicting outcome after potentially curative nephrectomy for renal cell carcinoma.
abstract: OBJECTIVE
  Preoperative C-reactive protein (CRP) predicts metastasis and mortality in localized renal cell carcinoma (RCC). However, the predictive potential of after resection of localized RCC remains unclear. Therefore, we assessed the absolute ability of postoperative CRP to predict metastases and mortality as a continuous variable.
  
  
  METHODS
  Patients with clinically localized (T1-T3N0M0) clear-cell RCC were followed for 1 year postoperatively. Metastases were identified radiologically and mortality by death certificate. Univariate and multivariate binary logistic regression analyses examined 1 year relapse-free survival (RFS) and overall survival (OS) across patient and disease characteristics.
  
  
  RESULTS
  Of the 110 patients in this study, 16.4% developed metastases and 6.4% died. Mean (SD) postoperative CRP for patients who did and did not develop metastases were 69.06 (73.55) mg/L and 5.27 (7.80), respectively. Mean (SD) postoperative CRP for patients who did and did not die were 89.31 (69.51) mg/L and 10.88 (30.32), respectively. In multivariate analysis, T-stage (OR: 12.452, 95% CI: 2.889-53.660) and postoperative CRP ((B: .080, SE: .025; P < .001) were significant predictors of RFS. T-Stage (OR: 11.715; 95% CI: 1.102-124.519) and postoperative CRP (B: .017; SE: .007; P < .001) were also significant predictors of OS. After adjusting for postoperative CRP, preoperative CRP was not predictive of these outcomes.
  
  
  CONCLUSIONS
  Postoperative, not preoperative, CRP is the better predictor of metastasis and mortality following nephrectomy for localized RCC. Clinicians should consider absolute postoperative CRP to identify high-risk patients for closer surveillance or additional therapy. Predictive algorithms should consider incorporating postoperative CRP as a continuous variable to maximize predictive ability.
authors.affiliation: Department of Urology, Emory University, Atlanta, Georgia, USA.
authors.forename: T V
authors.initials: TV
authors.lastname: Johnson
authors.forename: A
authors.initials: A
authors.lastname: Abbasi
authors.forename: A
authors.initials: A
authors.lastname: Owen-Smith
authors.forename: A N
authors.initials: AN
authors.lastname: Young
authors.forename: O
authors.initials: O
authors.lastname: Kucuk
authors.forename: W B
authors.initials: WB
authors.lastname: Harris
authors.forename: A O
authors.initials: AO
authors.lastname: Osunkoya
authors.forename: K
authors.initials: K
authors.lastname: Ogan
authors.forename: J
authors.initials: J
authors.lastname: Pattaras
authors.forename: P T
authors.initials: PT
authors.lastname: Nieh
authors.forename: F F
authors.initials: FF
authors.lastname: Marshall
authors.forename: V A
authors.initials: VA
authors.lastname: Master
mesh_terms: D002097:C-Reactive Protein / Q000032:analysis*; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy; D011184:Postoperative Period; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D002097:C-Reactive Protein