Saito Kazutaka, Kawakami Satoru, Ohtsuka Yukihiro, Fujii Yasuhisa, Masuda Hitoshi, Kumagai Jiro, Kobayashi Tsuyoshi, Kageyama Yukio, Kihara Kazunori
Department of Urology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
BJU Int. 2007 Aug;100(2):269-73. doi: 10.1111/j.1464-410X.2007.06934.x. Epub 2007 May 4.
To assess the impact of preoperative C-reactive protein (CRP) levels on the prognosis in patients with upper urinary tract (UUT) urothelial carcinoma (UC) primarily treated surgically, as it is increasingly recognized that a systemic inflammatory response is associated with the prognosis for patients with various malignancies.
The clinical records of 130 patients treated surgically for UUT-UC were reviewed retrospectively. An elevated CRP was defined as >0.5 mg/dL. Actuarial survival curves were calculated by Kaplan-Meier method, with the difference between curves evaluated using the log-rank test. A multivariate analysis was used to identify prognostic factors, with Cox's proportional hazard model.
The median (range) follow-up was 47 (3-190) months. The preoperative serum CRP level was elevated in 24 patients (23%). There were significant associations between CRP level and haemoglobin concentrations, pathological T stage, tumour grade, lymph node involvement and lymphovascular invasion. The 5-year disease-specific and recurrence-free survival rates of 24 patients with elevated CRP were significantly worse than those of the 106 with no CRP elevation (both P < 0.001). On multivariate analysis, preoperative CRP level, pathological T stage and lymph node involvement were significant prognostic factors for disease-specific and recurrence-free survival.
This study indicated that an elevated preoperative CRP level predicts a poor survival in patients with UUT-UC.
评估术前C反应蛋白（CRP）水平对主要接受手术治疗的上尿路（UUT）尿路上皮癌（UC）患者预后的影响，因为越来越多的人认识到全身炎症反应与各种恶性肿瘤患者的预后相关。
回顾性分析130例接受手术治疗的UUT-UC患者的临床记录。CRP升高定义为>0.5mg/dL。采用Kaplan-Meier法计算精算生存曲线，使用对数秩检验评估曲线之间的差异。采用多变量分析，用Cox比例风险模型确定预后因素。
中位（范围）随访时间为47（3-190）个月。24例患者（23%）术前血清CRP水平升高。CRP水平与血红蛋白浓度、病理T分期、肿瘤分级、淋巴结受累及淋巴管浸润之间存在显著相关性。24例CRP升高患者的5年疾病特异性生存率和无复发生存率显著低于106例CRP未升高患者（均P<0.001）。多变量分析显示，术前CRP水平、病理T分期和淋巴结受累是疾病特异性生存和无复发生存的显著预后因素。
本研究表明，术前CRP水平升高预示UUT-UC患者生存不良。
