Saito Kazutaka, Tatokoro Manabu, Fujii Yasuhisa, Iimura Yasumasa, Koga Fumitaka, Kawakami Satoru, Kihara Kazunori
Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan.
Eur Urol. 2009 May;55(5):1145-53. doi: 10.1016/j.eururo.2008.10.012. Epub 2008 Oct 14.
Pretreatment C-reactive protein (CRP) level has been shown to be prognostic for metastatic renal cell carcinoma (mRCC).
To demonstrate that CRP would be a biomarker for mRCC, we evaluated the impact of CRP kinetics on survival.
DESIGN, SETTING, AND PARTICIPANTS: One hundred eight patients with mRCC were treated from 1994 to 2007 with a median follow-up period of 18 mo (interquartile range: 7-40 mo).
All patients underwent multimodal therapeutic intervention.
Patients were divided into three groups according to CRP kinetics. Patients whose pretreatment CRP levels were <5mg/l, patients whose pretreatment CRP levels were >5mg/l and normalized (<5mg/l) at least one time during treatment, and patients whose pretreatment CRP levels were >5mg/l and never normalized were assigned to nonelevated, normalized, and non-normalized CRP groups, respectively. The prognostic impact of CRP kinetics and the correlation between normalized CRP period and overall survival period were determined.
In 61 of the 108 patients (56%), CRP levels were elevated at the diagnosis of mRCC. During treatment, CRP levels were normalized in 30 of 61 patients (49%), whereas CRP levels remained elevated in the remaining 31 patients. Overall survival rates were significantly different between nonelevated, normalized, and non-normalized CRP groups (p<0.001) with 2-yr survival rates of 69%, 55%, and 4%, respectively. In multivariate analysis, CRP kinetics was an independent significant factor for overall survival. Normalized CRP period was significantly correlated with overall survival period in 78 patients who died of disease. Since this is a small retrospective study on patients within the past era of immunotherapy, larger confirmatory studies in the current era of targeted therapy are needed.
CRP can be a novel, widely available biomarker for patients with mRCC.
治疗前C反应蛋白（CRP）水平已被证明对转移性肾细胞癌（mRCC）具有预后价值。
为证明CRP可作为mRCC的生物标志物，我们评估了CRP动态变化对生存的影响。
设计、背景和参与者：1994年至2007年期间，对108例mRCC患者进行了治疗，中位随访期为18个月（四分位间距：7 - 40个月）。
所有患者均接受了多模式治疗干预。
根据CRP动态变化将患者分为三组。治疗前CRP水平<5mg/l的患者、治疗前CRP水平>5mg/l且在治疗期间至少有一次恢复正常（<5mg/l）的患者、治疗前CRP水平>5mg/l且从未恢复正常的患者，分别被分配到CRP未升高组、CRP恢复正常组和CRP未恢复正常组。确定CRP动态变化的预后影响以及CRP恢复正常时间与总生存期之间的相关性。
108例患者中有61例（56%）在mRCC诊断时CRP水平升高。治疗期间，61例患者中有30例（49%）CRP水平恢复正常，而其余31例患者的CRP水平仍保持升高。CRP未升高组、CRP恢复正常组和CRP未恢复正常组的总生存率存在显著差异（p<0.001），2年生存率分别为69%、55%和4%。在多变量分析中，CRP动态变化是总生存的独立显著因素。在78例死于疾病的患者中，CRP恢复正常时间与总生存期显著相关。由于这是一项针对过去免疫治疗时代患者的小型回顾性研究，因此需要在当前靶向治疗时代进行更大规模的验证性研究。
CRP可成为mRCC患者一种新型的、广泛可用的生物标志物。
