title: Preoperative serum C- reactive protein: a prognostic marker in patients with upper urinary tract urothelial carcinoma.
abstract: BACKGROUND
  To analyse the prognostic significance of preoperative C-reactive protein (CRP) serum level in patients with upper urinary tract urothelial carcinoma (UUT-UC).
  
  
  METHODS
  We evaluated 158 UUT-UC patients who had undergone surgery in the University Hospital of Hannover (MHH). 143 (89.4%) suffered from cancer in the renal pelvis, 13 (8.1%) patients presented with tumour located in the ureter. A preoperative CRP value was available for 115 patients. The mean (median) follow-up for these patients was 28.3 (15.1) months.
  
  
  RESULTS
  The median (mean) CRP value of all evaluable patients was 10.0 (40.7) mg/l. The CRP-level, stratified into two subgroups (CRP ≤5 vs. >5 mg/l), correlated significantly with muscle invasive tumour stage (36.4 vs. 78.9%; p<0.001), the risk of presenting nodal disease (4.5 vs. 26.8%; p=0.002) and distant metastasis (2.3 vs. 16.9%; p<0.016). The Kaplan-Meier 5-year cancer specific survival (CSS) rates were 54.2 and 26.4% for patients with preoperative CRP levels ≤ and >5 mg/l, respectively (p<0.006). Next to age and the presence of metastasis, multivariate analysis also identified CRP as a continuous variable as an independent prognosticator for CSS.
  
  
  CONCLUSIONS
  A high preoperative serum CRP level is associated with locally advanced and metastatic disease in patients with UUT-UC. Its routine use could allow better risk stratification and risk-adjusted follow-up of UUT-UC patients.
authors.affiliation: Department of Urology, Hannover Medical School, Carl-Neuberg-Str, 1, Hannover, D-30625, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Stein
authors.forename: Andres Jan
authors.initials: AJ
authors.lastname: Schrader
authors.forename: Gerd
authors.initials: G
authors.lastname: Wegener
authors.forename: Christoph
authors.initials: C
authors.lastname: Seidel
authors.forename: Markus A
authors.initials: MA
authors.lastname: Kuczyk
authors.forename: Sandra
authors.initials: S
authors.lastname: Steffens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D002277:Carcinoma / Q000097:blood* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000097:blood* / Q000401:mortality; D007682:Kidney Pelvis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057234:Preoperative Period; D011379:Prognosis; D014516:Ureteral Neoplasms / Q000097:blood* / Q000401:mortality
chemical_list: D014408:Biomarkers, Tumor; D002097:C-Reactive Protein