Chen Wei, Tanaka Hajime, Kobayashi Masaki, Fukuda Shohei, Nakayama Akinori, Meagher Margaret F, Yoshida Soichiro, Derweesh Ithaar H, Master Viraj A, Hirakawa Akihiro, Fujii Yasuhisa, Saito Kazutaka
Department of Urology, Institute of Science Tokyo, Tokyo, Japan.
Department of Urology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
Int J Urol. 2025 Apr;32(4):414-422. doi: 10.1111/iju.15671. Epub 2025 Jan 4.
C-reactive protein (CRP) is a prognostic biomarker for clear cell renal cell carcinoma (ccRCC). However, there may be potential racial heterogeneity in distribution and prognostic impact of CRP level. We investigated potential racial differences in distribution and prognostic impact of preoperative CRP among Asian (AS), African American (AA), and Caucasian (CAUC) patients with non-metastatic ccRCC (nmccRCC).
We retrospectively analyzed 1991 nmccRCC cases (AS/AA/CAUC: n = 968/223/800) undergoing nephrectomy from the international multi-institutional database. We investigated CRP distributions and optimal cut-off values for predicting recurrence-free survival (RFS) and overall survival (OS) using Cox regressions for each racial group. Subgroup analyses considered comorbidities, pathological T stage, and Fuhrman grade.
Preoperative CRP distributions differed significantly among the races, with median values of 0.90 mg/L (interquartile range, 0.40-2.33) for AS, 5.00 mg/L (1.98-12.20) for AA, and 3.55 mg/L (1.41-8.48) for CAUC (p < 0.01). Optimal cut-off values for RFS were 1.2 mg/L in AS, 2.8 mg/L in AA, and 1.7 mg/L in CAUC, showing C-indices of 0.77, 0.71, and 0.77, respectively. For OS, they were 1.6 mg/L in AS, 8.3 mg/L in AA, and 9.3 mg/L in CAUC, yielding C-indices of 0.77, 0.70, and 0.74, respectively. Subgroup analyses revealed varying reference ranges of CRP levels among races (1.1-2.2/2.7-5.0/1.5-3.4 mg/L for RFS, and AS/AA/CAUC: 0.9-3.0/8.0-12.7/8.0-10.4 mg/L for OS, respectively).
The preoperative CRP distributions and their optimal cut-off values for predicting patient prognosis differed significantly among the races. Using race-specific cut-off values, CRP demonstrated consistently high-prognostic accuracies, which may improve tailored patient management in nmccRCC.
C反应蛋白（CRP）是透明细胞肾细胞癌（ccRCC）的一种预后生物标志物。然而，CRP水平的分布及其预后影响可能存在潜在的种族异质性。我们调查了亚洲（AS）、非裔美国人（AA）和白种人（CAUC）非转移性ccRCC（nmccRCC）患者术前CRP在分布和预后影响方面的潜在种族差异。
我们回顾性分析了来自国际多机构数据库的1991例接受肾切除术的nmccRCC病例（AS/AA/CAUC：n = 968/223/800）。我们使用Cox回归分析每个种族组预测无复发生存期（RFS）和总生存期（OS）的CRP分布及最佳临界值。亚组分析考虑了合并症、病理T分期和Fuhrman分级。
术前CRP分布在不同种族间存在显著差异，AS组的中位数为0.90mg/L（四分位间距，0.40 - 2.33），AA组为5.00mg/L（1.98 - 12.20），CAUC组为3.55mg/L（1.41 - 8.48）（p < 0.01）。RFS的最佳临界值在AS组为1.2mg/L，AA组为2.8mg/L，CAUC组为1.7mg/L，C指数分别为0.77、0.71和0.77。对于OS，AS组为1.6mg/L，AA组为8.3mg/L，CAUC组为9.3mg/L，C指数分别为0.77、0.70和0.74。亚组分析显示不同种族间CRP水平的参考范围不同（RFS为1.1 - 2.2/2.7 - 5.0/1.5 - 3.4mg/L，OS的AS/AA/CAUC组分别为0.9 - 3.0/8.0 - 12.7/8.0 - 10.4mg/L）。
术前CRP分布及其预测患者预后的最佳临界值在不同种族间存在显著差异。使用种族特异性临界值，CRP显示出始终较高的预后准确性，这可能改善nmccRCC患者的个体化管理。
