Ishiyama Yudai, Kondo Tsunenori, Ishihara Hiroki, Yoshida Kazuhiko, Iizuka Junpei, Tanabe Kazunari, Takagi Toshio
Department of Urology, Tokyo Women's Medical University Adachi Medical Center, 4-33-1 Kouhoku, Adachi-ku, Tokyo, 123-8558, Japan.
Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan.
Int J Clin Oncol. 2022 May;27(5):969-976. doi: 10.1007/s10147-022-02136-6. Epub 2022 Feb 12.
With new options in adjuvant settings, clinical biomarkers to predict recurrence after radical surgery for high-risk renal cell carcinoma (hrRCC) are in need but are scarcely investigated. We aimed to verify the predictive value of perioperative C-reactive protein (CRP) kinetics on hrRCC recurrence.
We retrospectively evaluated 154 patients who underwent radical surgery for hrRCC (≥ pT3 and/or N1-2 and M0) at two institutions. Patients were classified into Normal (< 0.5) and High (≥ 0.5) according to their preoperative serum CRP (mg/dL). The High group were further classified into Normalized (< 0.5 at post) or Non-normalized (≥ 0.5 at post), and recurrence-free survival (RFS) was compared between groups. Factors for RFS were further analysed, and Harrell's concordance index (C-index) for the accuracy of predicting RFS was compared with and without the addition of CRP-related variables to pre-existing models.
The RFS was significantly shorter in the High (n = 72, 46.8%) compared to the Normal (n = 82, 53.2%) group (9.7 vs. 66.7 months, p < 0.001). Within the High group, Non-normalized (n = 27, 17.5%) patients showed a significantly shorter RFS compared to the Normalized (n = 45, 29.2%) group (6.2 vs. 20.3, p = 0.009). In the multivariable stepwise analysis, CRP kinetics (hazard ratio 2.15, p = 0.029) effectively predicted RFS while baseline CRP fell short of significance. Higher C-index improvement was observed with CRP non-normalization than the baseline value when added to factors in the Karakiewicz and University of California Los Angeles Integrated Staging System models.
CRP kinetics effectively predicted RCC recurrence after surgery and may aid in decision-making for adjuvant systemic therapy.
随着辅助治疗方案的不断更新，预测高危肾细胞癌（hrRCC）根治性手术后复发的临床生物标志物亟待研究，但相关研究较少。我们旨在验证围手术期C反应蛋白（CRP）动力学对hrRCC复发的预测价值。
我们回顾性评估了两家机构中154例行hrRCC根治性手术（≥pT3和/或N1-2和M0）的患者。根据术前血清CRP（mg/dL）将患者分为正常组（<0.5）和高值组（≥0.5）。高值组进一步分为恢复正常组（术后<0.5）或未恢复正常组（术后≥0.5），并比较各组的无复发生存期（RFS）。进一步分析RFS的相关因素，并比较在现有模型中加入和不加入CRP相关变量时预测RFS准确性的Harrell一致性指数（C指数）。
高值组（n = 72，46.8%）的RFS明显短于正常组（n = 82，53.2%）（9.7个月对66.7个月，p < 0.001）。在高值组中，未恢复正常组（n = 27，17.5%）患者的RFS明显短于恢复正常组（n = 45，29.2%）（6.2个月对20.3个月，p = 0.009）。在多变量逐步分析中，CRP动力学（风险比2.15，p = 0.029）有效预测了RFS，而基线CRP未达到显著水平。当将CRP未恢复正常这一因素添加到Karakiewicz和加利福尼亚大学洛杉矶分校综合分期系统模型的因素中时，观察到C指数的改善高于基线值。
CRP动力学有效预测了RCC术后复发，并可能有助于辅助全身治疗的决策制定。
