title: C-reactive protein in patients with advanced metastatic renal cell carcinoma: usefulness in identifying patients most likely to benefit from initial nephrectomy.
abstract: OBJECTIVE
  C-reactive protein (CRP) is considered a useful serum marker for patients with RCC. However, its clinical utility in advanced metastatic renal cell carcinoma (AM-RCC), particularly in deciding whether to perform nephrectomy at the onset, is not well studied.
  
  
  METHODS
  We retrospectively evaluated 181 patients with AM-RCC, including 18 patients underwent potentially curative surgery, 111 underwent cytoreductive nephrectomy, and 52 received medical treatment only. CRP cutoff points were determined by receiver operating characteristic (ROC) curve analysis. Kaplan-Meier and Cox regression analyses were used for survival tests.
  
  
  RESULTS
  ROC analysis suggested that grouping patients according to 3 CRP ranges was a rational model. Patients with highly elevated CRP (≥67.0 mg/L) presented remarkably poor prognosis despite treatment (nephrectomy or medical treatment only). Cox regression models demonstrated that risk factors of overall survival for patients who underwent nephrectomy were the CRP ranges defined in this study (≤18.0 mg/L, >18.0 and <67.0 mg/L, and ≥67.0 mg/L), ECOG PS (0, 1, and ≥2), and number of metastatic organ sites (0-1 and ≥2). The retrospective design is a limitation of this study.
  
  
  CONCLUSIONS
  Our study demonstrated that the serum CRP level is a statistically significant prognostic parameter for patients with AM-RCC. The data also indicated that pretreatment serum CRP level provides useful prognostic information that helps in deciding whether to perform initial nephrectomy for patients with AM-RCC.
authors.affiliation: Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan. pug_daikichi@yahoo.co.jp
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ito
authors.forename: Koichi
authors.initials: K
authors.lastname: Shioi
authors.forename: Takayuki
authors.initials: T
authors.lastname: Murakami
authors.forename: Akitoshi
authors.initials: A
authors.lastname: Takizawa
authors.forename: Futoshi
authors.initials: F
authors.lastname: Sano
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawahara
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Mizuno
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Makiyama
authors.forename: Noboru
authors.initials: N
authors.lastname: Nakaigawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kishida
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miura
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kubota
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism*; D002292:Carcinoma, Renal Cell / Q000378:metabolism* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000378:metabolism* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009392:Nephrectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D002097:C-Reactive Protein