title: Validation of CRP as prognostic marker for renal cell carcinoma in a large series of patients.
abstract: BACKGROUND
  To evaluate the prognostic significance of the pre-operative C-reactive protein (CRP) serum level in patients with renal cell cancer (RCC).
  
  
  METHODS
  We evaluated 1,161 RCC patients with complete patient and tumour specific characteristics as well as information about their pre-operative CRP-level, who had undergone either radical nephrectomy or nephron-sparing surgery at two German high-volume centres (University Hospitals of Hannover and Ulm). The mean follow-up was 54 months.
  
  
  RESULTS
  The CRP-level, stratified to three subgroups (CRP ≤ 4, 4-10, and >10 mg/l), correlated significantly with tumour stage (p < 0.001), the risk of presenting nodal disease (2.1, 3.1, and 16.4%) and distant metastasis (2.9, 8.6, and 30.0%; p < 0.001). The Kaplan-Meier 5-year cancer specific survival (CSS) rates were 89.4, 77.9, and 49.5%, respectively (p < 0.001). Multivariate analysis identified CRP as an independent prognosticator for CSS as well as overall survival (p < 0.001). Patients with a CRP of 4-10 and >10 mg/l had a 1.67 and 2.48 fold higher risk of dying due to their RCC compared to those with a pre-operative CRP ≤4 mg/l, respectively.
  
  
  CONCLUSIONS
  A high preoperative serum CRP level is an independent predictor of poor survival in patients with RCC. Its routine use could allow better risk stratification and risk-adjusted follow-up of RCC patients.
authors.affiliation: Department of Urology, Hannover Medical School, Carl-Neuberg-Str, 1, D-30625, Hannover, Germany. steffens.sandra@mh-hannover.de
authors.forename: Sandra
authors.initials: S
authors.lastname: Steffens
authors.forename: Astrid
authors.initials: A
authors.lastname: Köhler
authors.forename: Raphael
authors.initials: R
authors.lastname: Rudolph
authors.forename: Hendrik
authors.initials: H
authors.lastname: Eggers
authors.forename: Christoph
authors.initials: C
authors.lastname: Seidel
authors.forename: Martin
authors.initials: M
authors.lastname: Janssen
authors.forename: Gerd
authors.initials: G
authors.lastname: Wegener
authors.forename: Mark
authors.initials: M
authors.lastname: Schrader
authors.forename: Markus A
authors.initials: MA
authors.lastname: Kuczyk
authors.forename: Andres J
authors.initials: AJ
authors.lastname: Schrader
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism*; D002292:Carcinoma, Renal Cell / Q000097:blood* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057234:Preoperative Period; D011379:Prognosis; D015203:Reproducibility of Results; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D002097:C-Reactive Protein