title: Preoperative C-reactive protein in the serum: a prognostic biomarker for upper urinary tract urothelial carcinoma treated with radical nephroureterectomy.
abstract: OBJECTIVE
  To investigate the impact of preoperative serum C-reactive protein (CRP) on clinicopathological features and prognosis in patients with upper tract urothelial cancer (UTUC) after radical nephroureterectomy (RNU).
  
  
  METHODS
  Data of 265 patients from three German centers who underwent RNU for UTUC without neoadjuvant chemotherapy between 1990 and 2012 were evaluated. Mean follow-up was 37 months (interquartile range 9-48). CRP was analyzed as a categorical and continuous variable for the prediction of recurrence-free survival (RFS), disease-specific survival (DSS) and all-cause survival (ACS) using uni- and multivariate Cox regression analyses.
  
  
  RESULTS
  The optimal cutoff for CRP was calculated by the Youden index at 0.90 mg/dl. Elevated CRP was significantly associated with pT3/4 and pN+ in a preoperative model including age, gender, tumor multifocality, tumor localization and the Eastern Cooperative Oncology Group Performance Status. In a multivariable Cox regression model adjusted for features significant in univariable analysis, categorized and continuous CRP levels were both independent predictors for RFS [hazard ratio (HR) 1.18, p = 0.050; HR 1.03, p = 0.012] and DSS (HR 1.61, p = 0.026; HR 1.06, p = 0.001). Continuous CRP was an independent predictor for ACS (HR 1.05, p = 0.036).
  
  
  CONCLUSIONS
  Elevated preoperative CRP is significantly associated with aggressive tumor biology and an independent predictor for poor survival after RNU. Preoperative serum CRP represents an easily obtainable and cost-effective marker in UTUC and may help in counseling patients with regard to operative management and/or adjuvant or neoadjuvant therapies.
authors.affiliation: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
authors.forename: Atiqullah
authors.initials: A
authors.lastname: Aziz
authors.forename: Michael
authors.initials: M
authors.lastname: Rink
authors.forename: Georgios
authors.initials: G
authors.lastname: Gakis
authors.forename: Luis A
authors.initials: LA
authors.lastname: Kluth
authors.forename: Christopher
authors.initials: C
authors.lastname: Dechet
authors.forename: Florian
authors.initials: F
authors.lastname: Miller
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Otto
authors.forename: Michael
authors.initials: M
authors.lastname: Gierth
authors.forename: Stefan
authors.initials: S
authors.lastname: Denzinger
authors.forename: Christian
authors.initials: C
authors.lastname: Schwentner
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism*; D002277:Carcinoma / Q000097:blood* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000097:blood* / Q000601:surgery; D019459:Urothelium / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor; D002097:C-Reactive Protein