St James's Institute of Oncology, St James's University Hospital, Leeds, UK.
Br J Cancer. 2010 Nov 23;103(11):1649-56. doi: 10.1038/sj.bjc.6605973. Epub 2010 Nov 9.
Validated objective biomarkers are needed for patients with renal cell carcinoma (RCC) to guide patient management and define high-risk populations for follow-up or for therapeutic purposes.
Patients undergoing nephrectomy for RCC (n=286 all stages, 84% with conventional clear cell type) were included with a median duration follow-up of 5 years. The prognostic significance of pre-operative haematological and biochemical variables, including C-reactive protein (CRP) values were examined and whether they added additional information to a recently published pre-operative scoring system was determined.
C-reactive protein was the most significant predictor of overall survival (OS; χ(2)=50.9, P<0.001). Five-year OS for patients with CRP ≤ 15 mg l(-1) vs >15 mg l(-1) was 72% (95% CI 65-78%) and 33% (95% CI 23-44%), respectively. Similar results were seen for cancer-specific survival (CSS) and disease-free survival. On multivariate analysis, CRP remained highly significant for CSS (χ(2)=17.3, P<0.0001) and OS (χ(2)=9.8, P<0.002), in addition to other pre-operative variables including log of neutrophil/lymphocyte ratio, red blood cell count and white cell count. C-reactive protein was significant in addition to the pre-operative nomogram score (χ(2)=12.5, P=0.0004 for OS, χ(2)=16.2, P=0.0001 for CSS and χ(2)=8.6, P=0.003 for DFS) and was still significant when other pre-operative variables were included.
C-reactive protein and other haematological and biochemical variables have independent prognostic significance in RCC and may enhance pre-operative scoring systems.
需要经过验证的客观生物标志物来指导肾细胞癌（RCC）患者的管理，并确定高危人群进行随访或治疗。
纳入 286 例接受肾切除术的 RCC 患者（所有分期，84%为常规透明细胞型），中位随访时间为 5 年。检查术前血液学和生化变量（包括 C 反应蛋白（CRP）值）的预后意义，并确定它们是否为最近发表的术前评分系统提供了额外信息。
CRP 是总生存（OS）的最显著预测因子（χ(2)=50.9，P<0.001）。CRP≤15mg·l(-1)和>15mg·l(-1)的患者 5 年 OS 分别为 72%（95%CI 65-78%）和 33%（95%CI 23-44%）。CSS 和无病生存（DFS）也观察到类似的结果。多变量分析显示，CRP 对 CSS（χ(2)=17.3，P<0.0001）和 OS（χ(2)=9.8，P<0.002）仍然具有高度显著性，除了包括对数中性粒细胞/淋巴细胞比、红细胞计数和白细胞计数在内的其他术前变量。CRP 除了术前Nomogram 评分外仍然具有显著性（OS：χ(2)=12.5，P=0.0004；CSS：χ(2)=16.2，P=0.0001；DFS：χ(2)=8.6，P=0.003），当包括其他术前变量时仍然具有显著性。
CRP 和其他血液学和生化变量在 RCC 中具有独立的预后意义，可能增强术前评分系统。
