title: The predictive value of C-reactive protein for prognosis in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy: a multi-institutional study.
abstract: BACKGROUND
  Few studies have discussed the prognostic impact of serum C-reactive protein (CRP) level in upper tract urothelial carcinoma (UTUC).
  
  
  OBJECTIVE
  To investigate whether the perioperative level of CRP provides additional prognostic information following radical nephroureterectomy (RNU).
  
  
  METHODS
  A total of 564 patients with UTUC from a retrospective multi-institutional cohort were included. The median follow-up was 32 mo.
  
  
  METHODS
  All patients underwent RNU without neoadjuvant chemotherapy, while 106 patients (18.8%) received adjuvant chemotherapy.
  
  
  METHODS
  Associations between perioperative CRP level and outcome were assessed using multivariate analysis. A serum CRP level >0.50mg/dl was defined as elevated.
  
  
  CONCLUSIONS
  Preoperative CRP (pre-CRP) level was elevated in 136 patients (24.1%). Multivariate analysis showed that pre-CRP elevation was an independent predictor of subsequent disease recurrence (hazard ratio [HR]: 1.47 for CRP 0.51-2.00; HR: 1.89 for CRP >2.00). Five-year recurrence-free survival rates were 69.2% in patients with pre-CRP levels ≤ 0.50 mg/dl, 54.3% in patients with pre-CRP levels between 0.51 and 2.00 mg/dl, and 35.4% in patients with pre-CRP levels >2.00 mg/dl (p<0.001). Similar results were found in cancer-specific mortality, showing that pre-CRP elevation was an independent predictor of worse outcome (HR: 1.74 for CRP 0.51-2.00; HR: 2.31 for CRP >2.00). In a subgroup analysis of the elevated pre-CRP group, postoperative normalisation of CRP level was an independent predictor of better outcome. This study is limited by its retrospective nature as well as its heterogeneous group of patients and variable follow-up protocols resulting from the multi-institution design.
  
  
  CONCLUSIONS
  Serum CRP may become a possible biomarker in UTUC, suggesting that patients with an elevated pre-CRP level could be predicted to have subsequent disease recurrence and cancer-specific mortality, while postoperative normalisation of CRP level was an independent predictor for prognosis.
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saitama City Hospital, Saitama, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Tanaka
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Suguru
authors.initials: S
authors.lastname: Shirotake
authors.forename: Kent
authors.initials: K
authors.lastname: Kanao
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ide
authors.forename: Jun
authors.initials: J
authors.lastname: Obata
authors.forename: Katsura
authors.initials: K
authors.lastname: Hoshino
authors.forename: Nozomi
authors.initials: N
authors.lastname: Hayakawa
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Ito
authors.forename: Takeo
authors.initials: T
authors.lastname: Kosaka
authors.forename: Kiichiro
authors.initials: K
authors.lastname: Kodaira
authors.forename: Masafumi
authors.initials: M
authors.lastname: Oyama
authors.forename: Akira
authors.initials: A
authors.lastname: Miyajima
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Momma
authors.forename: Ken
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Munehisa
authors.initials: M
authors.lastname: Ueno
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Oya
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D002295:Carcinoma, Transitional Cell / Q000097:blood* / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood; D009392:Nephrectomy / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D014516:Ureteral Neoplasms / Q000097:blood* / Q000401:mortality / Q000601:surgery*
chemical_list: D002097:C-Reactive Protein