Improving the accuracy of pre-operative survival prediction in renal cell carcinoma with C-reactive protein

Abstract

Background: Validated objective biomarkers are needed for patients with renal cell carcinoma (RCC) to guide patient management and define high-risk populations for follow-up or for therapeutic purposes. Methods: Patients undergoing nephrectomy for RCC (n=286 all stages, 84% with conventional clear cell type) were included with a median duration follow-up of 5 years. The prognostic significance of pre-operative haematological and biochemical variables, including C-reactive protein (CRP) values were examined and whether they added additional information to a recently published pre-operative scoring system was determined. Results : C-reactive protein was the most significant predictor of overall survival (OS; 2 50.9, P< 0.001). Five-year OS for patients with CRP15 mg l 1 vs 15 mg l 1 was 72% (95% CI 65-78%) and 33% (95% CI 23-44%), respectively. Similar results were seen for cancer-specific survival (CSS) and disease-free survival. On multivariate analysis, CRP remained highly significant for CSS ( 2 17.3, P< 0.0001) and OS ( 2 9.8, P< 0.002), in addition to other pre-operative variables including log of neutrophil/lymphocyte ratio, red blood cell count and white cell count. C-reactive protein was significant in addition to the pre-operative nomogram score ( 2 12.5, P< 0.0004 for OS, 2 16.2, P< 0.0001 for CSS and 2 8.6, P< 0.003 for DFS) and was still significant when other pre-operative variables were included. Conclusion : C-reactive protein and other haematological and biochemical variables have independent prognostic significance in RCC and may enhance pre-operative scoring systems. © 2010 Cancer Research UK.