Chen Wei, Tanaka Hajime, Kobayashi Masaki, Fukuda Shohei, Nakayama Akinori, Meagher Margaret F, Greenwald Rachel, Schmeusser Benjamin, Nicase Edouard, Waseda Yuma, Yoshida Soichiro, Derweesh Ithaar H, Master Viraj A, Fujii Yasuhisa, Saito Kazutaka
Department of Urology, Institute of Science Tokyo, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan.
Department of Urology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
World J Urol. 2025 Jan 9;43(1):63. doi: 10.1007/s00345-024-05421-3.
Preoperative C-reactive protein (CRP) is a valuable prognostic biomarker in nonmetastatic clear cell renal cell carcinoma (nmccRCC). Incorporation of CRP into prognostic models may improve the prediction of oncologic outcomes. Herein, we aimed to develop and validate prognostic nomograms and an integrated software incorporating preoperative CRP level in nmccRCC.
An international multi-institutional database was retrospectively analyzed for nmccRCC patients undergoing surgery. A total of 2284 patients were enrolled and randomly allocated to training (n = 1599, 70%) and validation (n= 685, 30%) cohorts. Nomograms predicting overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were developed in the training cohort using multivariable Cox regression, including preoperative CRP levels and other clinical factors. An integrated software was also created. The validation cohort was used to assess the performance of these nomograms.
Following a median follow-up of 5.9 years, 318 (13.92%) patients died of any cause, 109 (4.77%) died of renal cancer, and 282 (12.35%) developed recurrence. The median (interquartile range) preoperative CRP level was 1.90 (0.80-5.68) mg/L. A high CRP level was independently associated with worse OS, CSS, and RFS. The nomograms and integrated software incorporating CRP significantly improved prediction accuracy compared with CRP alone. The C-indices for nomograms were 0.74 (95%CI, 0.69-0.80) for OS, 0.87 (0.82-0.93) for CSS, and 0.77 (0.71-0.82) for RFS in the validation cohort. Acceptable calibration was demonstrated at 12/36/60 months for OS, CSS, and RFS.
The prognostic nomograms and the user-friendly integrated software incorporating preoperative CRP level may facilitate individualized risk stratification and treatment planning for patients with nmccRCC.
术前C反应蛋白（CRP）是非转移性透明细胞肾细胞癌（nmccRCC）中一种有价值的预后生物标志物。将CRP纳入预后模型可能会改善肿瘤学结局的预测。在此，我们旨在开发并验证nmccRCC患者的预后列线图以及整合术前CRP水平的综合软件。
对接受手术的nmccRCC患者的国际多机构数据库进行回顾性分析。共纳入2284例患者，并随机分配至训练队列（n = 1599，70%）和验证队列（n = 685，30%）。使用多变量Cox回归在训练队列中构建预测总生存期（OS）、癌症特异性生存期（CSS）和无复发生存期（RFS）的列线图，包括术前CRP水平和其他临床因素。还创建了一个综合软件。验证队列用于评估这些列线图的性能。
中位随访5.9年，318例（13.92%）患者死于任何原因，109例（4.77%）死于肾癌，282例（12.35%）出现复发。术前CRP水平的中位数（四分位间距）为1.90（0.80 - 5.68）mg/L。高CRP水平与较差的OS、CSS和RFS独立相关。与单独使用CRP相比，纳入CRP的列线图和综合软件显著提高了预测准确性。验证队列中，OS列线图的C指数为0.74（95%CI，0.69 - 0.80），CSS为0.87（0.82 - 0.93），RFS为0.77（0.71 - 0.82）。在OS、CSS和RFS的12/36/60个月时显示出可接受的校准。
纳入术前CRP水平的预后列线图和用户友好的综合软件可能有助于nmccRCC患者的个体化风险分层和治疗规划。
