Improving the accuracy of pre-operative survival prediction in renal cell carcinoma with C-reactive protein

BACKGROUND: Validated objective biomarkers are needed for patients with renal cell carcinoma (RCC) to guide patient management and define high-risk populations for follow-up or for therapeutic purposes. METHODS: Patients undergoing nephrectomy for RCC (n = 286 all stages, 84% with conventional clear cell type) were included with a median duration follow-up of 5 years. The prognostic significance of pre-operative haematological and biochemical variables, including C-reactive protein (CRP) values were examined and whether they added additional information to a recently published pre-operative scoring system was determined. RESULTS: C-reactive protein was the most significant predictor of overall survival (OS; chi(2) = 50.9, P<0.001). Five-year OS for patients with CRP <= 15 mg l(-1) vs > 15 mg l(-1) was 72% (95% CI 65-78%) and 33% (95% CI 23-44%), respectively. Similar results were seen for cancer-specific survival (CSS) and disease-free survival. On multivariate analysis, CRP remained highly significant for CSS (chi(2) = 17.3, P<0.0001) and OS (chi(2) = 9.8, P<0.002), in addition to other pre-operative variables including log of neutrophil/lymphocyte ratio, red blood cell count and white cell count. C-reactive protein was significant in addition to the pre-operative nomogram score (chi(2) = 12.5, P = 0.0004 for OS, chi(2) = 16.2, P = 0.0001 for CSS and chi(2) = 8.6, P = 0.003 for DFS) and was still significant when other pre-operative variables were included. CONCLUSION: C-reactive protein and other haematological and biochemical variables have independent prognostic significance in RCC and may enhance pre-operative scoring systems. British Journal of Cancer (2010) 103, 1649-1656. doi:10.1038/sj.bjc.6605973 www.bjcancer.com Published online 9 November 2010 (C) 2010 Cancer Research UK