Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saitama City Hospital, Saitama, Japan.
Eur Urol. 2014 Jan;65(1):227-34. doi: 10.1016/j.eururo.2012.11.050. Epub 2012 Dec 1.
Few studies have discussed the prognostic impact of serum C-reactive protein (CRP) level in upper tract urothelial carcinoma (UTUC).
To investigate whether the perioperative level of CRP provides additional prognostic information following radical nephroureterectomy (RNU).
DESIGN, SETTING, AND PARTICIPANTS: A total of 564 patients with UTUC from a retrospective multi-institutional cohort were included. The median follow-up was 32 mo.
All patients underwent RNU without neoadjuvant chemotherapy, while 106 patients (18.8%) received adjuvant chemotherapy.
Associations between perioperative CRP level and outcome were assessed using multivariate analysis. A serum CRP level >0.50mg/dl was defined as elevated.
Preoperative CRP (pre-CRP) level was elevated in 136 patients (24.1%). Multivariate analysis showed that pre-CRP elevation was an independent predictor of subsequent disease recurrence (hazard ratio [HR]: 1.47 for CRP 0.51-2.00; HR: 1.89 for CRP >2.00). Five-year recurrence-free survival rates were 69.2% in patients with pre-CRP levels ≤ 0.50 mg/dl, 54.3% in patients with pre-CRP levels between 0.51 and 2.00 mg/dl, and 35.4% in patients with pre-CRP levels >2.00 mg/dl (p<0.001). Similar results were found in cancer-specific mortality, showing that pre-CRP elevation was an independent predictor of worse outcome (HR: 1.74 for CRP 0.51-2.00; HR: 2.31 for CRP >2.00). In a subgroup analysis of the elevated pre-CRP group, postoperative normalisation of CRP level was an independent predictor of better outcome. This study is limited by its retrospective nature as well as its heterogeneous group of patients and variable follow-up protocols resulting from the multi-institution design.
Serum CRP may become a possible biomarker in UTUC, suggesting that patients with an elevated pre-CRP level could be predicted to have subsequent disease recurrence and cancer-specific mortality, while postoperative normalisation of CRP level was an independent predictor for prognosis.
很少有研究探讨血清 C 反应蛋白（CRP）水平在上尿路尿路上皮癌（UTUC）中的预后影响。
探讨根治性肾输尿管切除术（RNU）后 CRP 术前水平是否提供了额外的预后信息。
设计、设置和参与者：共纳入 564 例来自回顾性多机构队列的 UTUC 患者。中位随访时间为 32 个月。
所有患者均行 RNU 治疗，无新辅助化疗，106 例（18.8%）患者接受辅助化疗。
采用多变量分析评估术前 CRP 水平与预后的关系。将血清 CRP 水平>0.50mg/dl 定义为升高。
136 例（24.1%）患者术前 CRP（pre-CRP）水平升高。多变量分析显示，pre-CRP 升高是随后疾病复发的独立预测因素（CRP 0.51-2.00 时 HR：1.47；CRP>2.00 时 HR：1.89）。pre-CRP 水平≤0.50mg/dl 的患者 5 年无复发生存率为 69.2%，pre-CRP 水平在 0.51-2.00mg/dl 之间的患者为 54.3%，pre-CRP 水平>2.00mg/dl 的患者为 35.4%（p<0.001）。在癌症特异性死亡率方面也得到了相似的结果，表明 pre-CRP 升高是预后不良的独立预测因素（CRP 0.51-2.00 时 HR：1.74；CRP>2.00 时 HR：2.31）。在 pre-CRP 升高亚组分析中，CRP 术后正常化是预后良好的独立预测因素。本研究存在一定局限性，如回顾性设计、患者异质性以及多机构设计导致的不同随访方案。
血清 CRP 可能成为 UTUC 的一种潜在生物标志物，提示 pre-CRP 水平升高的患者可能会出现随后的疾病复发和癌症特异性死亡，而 CRP 术后正常化是预后的独立预测因素。
