Department of Urology, UC San Diego Health System, San Diego, CA.
Department of Urology, Emory Medical Center, Atlanta, GA.
Clin Genitourin Cancer. 2024 Jun;22(3):102098. doi: 10.1016/j.clgc.2024.102098. Epub 2024 Apr 18.
To evaluate relationship between histological subtypes of renal cell carcinoma (RCC) and preoperative c-reactive protein (CRP).
We queried the International Marker Consortium for Renal Cancer database for patients affected by RCC. Patients were classified according to their histology: benign tumors, clear cell (cc) RCC, chromophobe (ch) RCC, papillary (p) RCC, and variant histology (vh) RCC; and according to CRP (mg/L): low CRP ≤5 and high CRP >5. Primary outcome was all-cause mortality (ACM). Secondary outcomes were cancer-specific mortality (CSM), recurrence and association between CRP and histology. Multivariable analysis (MVA) via Cox regression and multivariable logistic regression were fitted to elucidate predictors of outcomes.
Total 3902 patients (high CRP n = 1266) were analyzed; median follow up 51 (IQR 20-91) months. On MVA elevated CRP was an independent risk factor associated with increased risk of ACM in benign tumors (HR 5.98, P < .001), ccRCC (HR 2.69, P < .001), chRCC (HR 3.99, P < .001), pRCC (HR 1.76, P = .009) and vhRCC (HR 2.97, P =.007). MVA for CSM showed CRP as risk factor in ccRCC (HR 2.77, P < .001), chRCC (HR 6.16, P = .003) and pRCC (HR 2.29, P = .011), while in vhRCC was not (P = .27). MVA for recurrence reported CRP as risk factor for ccRCC (HR 1.30, P = .013), while in chRCC (P = .33), pRCC (P = .34) and vhRCC (P = .52) was not. On multivariable logistic regression CRP was a predictor of pRCC (OR 1.003, P = .002), while decreasing CRP was associated with benign tumors (OR 0.994, P = .048).
Elevated CRP was a robust predictor of worsened ACM in all renal cortical neoplasms. While most frequently observed in pRCC patients, elevated CRP was independently associated with worsened CSM in non-vhRCC. Conversely, elevated CRP was least likely to be noted in benign tumors, and elevation in this subgroup of patients should prompt further consideration for surveillance given increased risk of ACM. Further investigation is requisite.
评估肾细胞癌（RCC）组织学亚型与术前 C 反应蛋白（CRP）之间的关系。
我们查询了国际肾脏肿瘤标志物协会数据库，以确定患有 RCC 的患者。根据组织学将患者分为良性肿瘤、透明细胞（cc）RCC、嫌色细胞（ch）RCC、乳头状（p）RCC 和变异组织学（vh）RCC；根据 CRP（mg/L）分为：低 CRP（CRP≤5）和高 CRP（CRP>5）。主要结局为全因死亡率（ACM）。次要结局为癌症特异性死亡率（CSM）、复发以及 CRP 与组织学之间的关系。通过 Cox 回归和多变量逻辑回归进行多变量分析（MVA），以阐明结局的预测因素。
共分析了 3902 例患者（高 CRP 组 n = 1266）；中位随访时间为 51（IQR 20-91）个月。在 MVA 中，CRP 升高是良性肿瘤（HR 5.98，P <.001）、ccRCC（HR 2.69，P <.001）、chRCC（HR 3.99，P <.001）、pRCC（HR 1.76，P =.009）和 vhRCC（HR 2.97，P =.007）中 ACM 风险增加的独立危险因素。对于 CSM 的 MVA 显示 CRP 是 ccRCC（HR 2.77，P <.001）、chRCC（HR 6.16，P =.003）和 pRCC（HR 2.29，P =.011）的危险因素，而在 vhRCC 中则不是（P =.27）。对于复发的 MVA 报告 CRP 是 ccRCC（HR 1.30，P =.013）的危险因素，而在 chRCC（P =.33）、pRCC（P =.34）和 vhRCC（P =.52）中则不是。在多变量逻辑回归中，CRP 是 pRCC 的预测因子（OR 1.003，P =.002），而 CRP 降低与良性肿瘤相关（OR 0.994，P =.048）。
CRP 升高是所有肾皮质肿瘤 ACM 恶化的有力预测因子。虽然在 pRCC 患者中最常见，但 CRP 升高与非 vhRCC 的 CSM 恶化独立相关。相反，在良性肿瘤中最不可能出现 CRP 升高，在该亚组患者中 CRP 升高提示 ACM 风险增加，应进一步考虑监测。需要进一步研究。
