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Keywords:

  • CRP;
  • inflammation;
  • recurrence;
  • accuracy;
  • prognosis;
  • kidney cancer

Objective

  • To validate high-sensitivity C-reactive protein (hs-CRP) serum levels as an independent marker for disease-free survival (DFS) in clinically localised clear cell renal cell carcinoma (ccRCC).

Patients and Methods

  • In all, 403 consecutive patients with clinically localised (T1–3N0M0) ccRCC treated by radical or partial nephrectomy were enrolled.
  • Preoperative serum levels of hs-CRP were evaluated as both a continuous and categorical variables.
  • Associations with clinical (age, gender) and pathological variables (T classification, grade, tumour necrosis) were assessed with the chi-square and Kruskal–Wallis tests.
  • Univariable and multivariable Cox proportional hazards models were fitted. The prognostic accuracy (PA) was assessed with Harrell's C-index.

Results

  • The mean hs-CRP level was 1.32 mg/dL. The hs-CRP levels were associated with T classification (P = 0.05), high-grade disease (P < 0.001) and tumour necrosis (P = 0.003).
  • After a median follow-up of 43 months, 41 patients (10.1%) had developed disease recurrence. With each unit increase in hs-CRP levels, the risk of recurrence increased by 10% (hazard ratio 1.10, P = 0.015).
  • The thresholds of 0.5 and 0.75 mg/dL showed the best discrimination for stratification of patients according to the probability of recurrence.
  • These categorically coded hs-CRP levels were identified as independent prognostic factors in multivariable analyses (P < 0.001) and led to a significant increase in the PA of a multivariable base model containing the variables of the ‘Stage, Size, Grade and Necrosis’ (SSIGN) score.

Conclusions

  • This study validates preoperative serum hs-CRP levels as independent prognostic factor after surgery for localised ccRCC.
  • Hs-CRP may be included in standard prognostic modelling after surgery and may guide surveillance and inclusion in adjuvant clinical trials.