Department of Urology, School of Medicine, Emory University, Atlanta, Georgia 30322, USA.
J Urol. 2010 Feb;183(2):480-5. doi: 10.1016/j.juro.2009.10.014. Epub 2009 Dec 14.
C-reactive protein is an inflammatory biomarker associated with tumor burden and metastasis in renal cell carcinoma. Recent studies suggest that preoperative C-reactive protein predicts metastasis and mortality after nephrectomy for localized renal cell carcinoma. However, these studies dichotomized C-reactive protein (typically 10 mg/l or greater vs less than 10 mg/l). Considering the continuous range of C-reactive protein (less than 1 mg/l to greater than 100 mg/l) we assessed the ability of absolute preoperative C-reactive protein to predict metastases and mortality as a continuous variable.
Patients with clinically localized (T1-T3N0M0) clear cell renal cell carcinoma were followed for 1 year postoperatively. Metastases were identified radiologically and mortality was determined by death certificate. Univariate and multivariate binary logistic regression analyses examined 1-year relapse-free survival and overall relative survival across patient and disease characteristics.
Of the 130 patients in this study metastases developed in 24.6% and 10.8% of the patients died. Mean (SD) preoperative C-reactive protein for patients in whom metastases did and did not develop was 89.17 (74.17) and 9.16 (30.62) mg/l, respectively. Mean preoperative C-reactive protein for patients who did and did not die was 102.61 (77.32) and 19.52 (46.10) mg/l, respectively. On multivariate analysis SSIGN score (p <0.001) and preoperative C-reactive protein (B 0.027, SE 0.003, p <0.001) were significant predictors of relapse-free survival, and preoperative platelets (p = 0.009) and preoperative C-reactive protein (B 0.011, SE 0.008, p <0.001) were significant predictors of overall relative survival.
Absolute preoperative C-reactive protein is a robust predictor of metastasis and mortality after nephrectomy for localized renal cell carcinoma. Clinicians should consider absolute preoperative C-reactive protein to identify high risk patients for closer surveillance or additional therapy. In addition, predictive algorithms and models of metastasis should consider incorporating C-reactive protein as a continuous variable to maximize predictive ability.
C-反应蛋白是一种与肾细胞癌肿瘤负担和转移相关的炎症生物标志物。最近的研究表明，术前 C-反应蛋白可预测局限性肾细胞癌肾切除术后的转移和死亡率。然而，这些研究将 C-反应蛋白（通常为 10mg/L 或更高与小于 10mg/L）进行了二分法。鉴于 C-反应蛋白的连续范围（小于 1mg/L 至大于 100mg/L），我们评估了绝对术前 C-反应蛋白作为连续变量预测转移和死亡的能力。
对接受临床局限性（T1-T3N0M0）透明细胞肾细胞癌肾切除术的患者进行了 1 年的术后随访。通过影像学确定转移，通过死亡证明确定死亡率。单变量和多变量二元逻辑回归分析检查了患者和疾病特征在 1 年无复发生存率和总相对生存率方面的变化。
在这项研究的 130 名患者中，24.6%和 10.8%的患者发生了转移，10.8%的患者死亡。发生转移和未发生转移的患者术前 C-反应蛋白的平均值（标准差）分别为 89.17（74.17）mg/L 和 9.16（30.62）mg/L。发生死亡和未发生死亡的患者术前 C-反应蛋白的平均值（标准差）分别为 102.61（77.32）mg/L 和 19.52（46.10）mg/L。多变量分析显示，SSIGN 评分（p<0.001）和术前 C-反应蛋白（B 0.027，SE 0.003，p<0.001）是无复发生存的显著预测因素，术前血小板（p=0.009）和术前 C-反应蛋白（B 0.011，SE 0.008，p<0.001）是总相对生存率的显著预测因素。
绝对术前 C-反应蛋白是肾细胞癌肾切除术后转移和死亡的可靠预测指标。临床医生应考虑使用绝对术前 C-反应蛋白来识别高危患者，以便进行更密切的监测或额外的治疗。此外，转移的预测算法和模型应考虑将 C-反应蛋白作为连续变量纳入，以最大限度地提高预测能力。
