title: Preoperative C-reactive protein level adjusted for comorbidities and lifestyle factors predicts overall mortality in localized renal cell carcinoma.
abstract: OBJECTIVE
  C-reactive protein (CRP), an acute phase reactant, is a non-specific marker of inflammation. Elevations in CRP levels are linked with trauma, infection, autoimmune disease, malignancy, and lifestyle factors, such as smoking and obesity. Previously, we noted a significant association between the preoperative CRP level, 1-year relapse-free survival, and 1-year overall relative survival in patients with localized renal cell carcinoma (RCC). This study sought to determine what effect, if any, lifestyle factors have on the prognostic value of preoperative CRP level for overall survival in individuals with localized RCC.
  
  
  METHODS
  257 patients with localized RCC who underwent nephrectomy were included in the study. Patients were enrolled between November 2006 and February 2010. The impact of tumor characteristics, lifestyle factors, and preoperative CRP level on overall survival was assessed through univariate and multivariate analyses.
  
  
  RESULTS
  During the study, 15.2% of patients died. Univariate analysis found that tumor size (p < 0.001), tumor stage (p < 0.001), Fuhrman nuclear grade (p < 0.001), Charlson Comorbidity Index score (p < 0.001), smoking status (p = 0.038), and preoperative CRP level (p < 0.001) were significantly associated with overall survival. Only the preoperative CRP level (odds ratio 1.035; 95% confidence interval 1.007, 1.064) remained significantly associated with overall survival upon multivariate analysis.
  
  
  CONCLUSIONS
  Prognostic tools serve an important role in cancer management. Thirty percent of patients with localized RCC ultimately develop metastatic disease despite having potentially curative nephrectomy. Previous research has identified the preoperative CRP level as a significant predictor of overall survival in patients with localized RCC. This study demonstrated that the CRP level remained a robust predictive tool when the analysis was controlled for lifestyle factors, including smoking and obesity. Consequently, clinicians should consider taking preoperative CRP levels into account when treating patients with localized RCC.
authors.affiliation: Department of Urology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Michigan
authors.forename: Timothy V
authors.initials: TV
authors.lastname: Johnson
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D002292:Carcinoma, Renal Cell / Q000097:blood / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015897:Comorbidity; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009392:Nephrectomy; D011379:Prognosis; D015996:Survival Rate
chemical_list: D016207:Cytokines; D002097:C-Reactive Protein