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Open Access Research article

Validation of CRP as prognostic marker for renal cell carcinoma in a large series of patients

Sandra Steffens1*, Astrid Köhler1*, Raphael Rudolph2, Hendrik Eggers1, Christoph Seidel3, Martin Janssen4, Gerd Wegener5, Mark Schrader2, Markus A Kuczyk1 and Andres J Schrader2

Author Affiliations

1 Department of Urology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany

2 Department of Urology, Ulm Medical School, Hannover, Germany

3 Department of Oncology, Hannover Medical School, Hannover, Germany

4 Department of Urology, University Clinic of Saarland, Homburg, Germany

5 Cancer Center, Hannover Medical School, Hannover, Germany

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BMC Cancer 2012, 12:399  doi:10.1186/1471-2407-12-399

Published: 8 September 2012

Abstract

Background

To evaluate the prognostic significance of the pre-operative C-reactive protein (CRP) serum level in patients with renal cell cancer (RCC).

Methods

We evaluated 1,161 RCC patients with complete patient and tumour specific characteristics as well as information about their pre-operative CRP-level, who had undergone either radical nephrectomy or nephron-sparing surgery at two German high-volume centres (University Hospitals of Hannover and Ulm). The mean follow-up was 54 months.

Results

The CRP-level, stratified to three subgroups (CRP ≤ 4, 4–10, and >10 mg/l), correlated significantly with tumour stage (p < 0.001), the risk of presenting nodal disease (2.1, 3.1, and 16.4%) and distant metastasis (2.9, 8.6, and 30.0%; p < 0.001). The Kaplan-Meier 5-year cancer specific survival (CSS) rates were 89.4, 77.9, and 49.5%, respectively (p < 0.001). Multivariate analysis identified CRP as an independent prognosticator for CSS as well as overall survival (p < 0.001). Patients with a CRP of 4–10 and >10 mg/l had a 1.67 and 2.48 fold higher risk of dying due to their RCC compared to those with a pre-operative CRP ≤4 mg/l, respectively.

Conclusions

A high preoperative serum CRP level is an independent predictor of poor survival in patients with RCC. Its routine use could allow better risk stratification and risk-adjusted follow-up of RCC patients.

Keywords:
Renal cell cancer; Biomarker; C-reactive protein; Prognosis; Survival