Open Access Highly Accessed Research article

C-reactive protein in patients with advanced metastatic renal cell carcinoma: Usefulness in identifying patients most likely to benefit from initial nephrectomy

Hiroki Ito1*, Koichi Shioi2, Takayuki Murakami1, Akitoshi Takizawa2, Futoshi Sano1, Takashi Kawahara1, Nobuhiko Mizuno1, Kazuhide Makiyama1, Noboru Nakaigawa1, Takeshi Kishida2, Takeshi Miura2, Yoshinobu Kubota1 and Masahiro Yao1

Author Affiliations

1 Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan

2 Department of Urology, Kanagawa Cancer Center, Yokohama, Japan

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BMC Cancer 2012, 12:337  doi:10.1186/1471-2407-12-337

Published: 2 August 2012

Abstract

Objective

C-reactive protein (CRP) is considered a useful serum marker for patients with RCC. However, its clinical utility in advanced metastatic renal cell carcinoma (AM-RCC), particularly in deciding whether to perform nephrectomy at the onset, is not well studied.

Patients and methods

We retrospectively evaluated 181 patients with AM-RCC, including 18 patients underwent potentially curative surgery, 111 underwent cytoreductive nephrectomy, and 52 received medical treatment only. CRP cutoff points were determined by receiver operating characteristic (ROC) curve analysis. Kaplan-Meier and Cox regression analyses were used for survival tests.

Results

ROC analysis suggested that grouping patients according to 3 CRP ranges was a rational model. Patients with highly elevated CRP (≥67.0 mg/L) presented remarkably poor prognosis despite treatment (nephrectomy or medical treatment only). Cox regression models demonstrated that risk factors of overall survival for patients who underwent nephrectomy were the CRP ranges defined in this study (≤18.0 mg/L, >18.0 and <67.0 mg/L, and ≥67.0 mg/L), ECOG PS (0, 1, and ≥2), and number of metastatic organ sites (0–1 and ≥2). The retrospective design is a limitation of this study.

Conclusion

Our study demonstrated that the serum CRP level is a statistically significant prognostic parameter for patients with AM-RCC. The data also indicated that pretreatment serum CRP level provides useful prognostic information that helps in deciding whether to perform initial nephrectomy for patients with AM-RCC.

Keywords:
C-reactive protein; Rena cell carcinoma; Prognosis