744 NOMOGRAMS INCORPORATING SERUM C-REACTIVE PROTEIN (CRP) LEVELS EFFECTIVELY PREDICT MORTALITY AFTER NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Evaluation & Staging (II)1 Apr 2013744 NOMOGRAMS INCORPORATING SERUM C-REACTIVE PROTEIN (CRP) LEVELS EFFECTIVELY PREDICT MORTALITY AFTER NEPHRECTOMY Wayland Hsiao, Lindsey Herrel, Changhong Yu, Michael Kattan, Kenneth Ogan, Daniel Canter, John Pattaras, Peter Nieh, Wayne Harris, Bradley Carthon, Omer Kucuk, and Viraj Master Wayland HsiaoWayland Hsiao Atlanta, GA More articles by this author , Lindsey HerrelLindsey Herrel Atlanta, GA More articles by this author , Changhong YuChanghong Yu Cleveland, OH More articles by this author , Michael KattanMichael Kattan Cleveland, OH More articles by this author , Kenneth OganKenneth Ogan Atlanta, GA More articles by this author , Daniel CanterDaniel Canter Atlanta, GA More articles by this author , John PattarasJohn Pattaras Atlanta, GA More articles by this author , Peter NiehPeter Nieh Atlanta, GA More articles by this author , Wayne HarrisWayne Harris Atlanta, GA More articles by this author , Bradley CarthonBradley Carthon Atlanta, GA More articles by this author , Omer KucukOmer Kucuk Atlanta, GA More articles by this author , and Viraj MasterViraj Master Atlanta, GA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.307AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal cell carcinoma (RCC) demonstrates heterogeneous behavior, and current tools are imperfect for predicting survival. The SSIGN score has proven utility in predicting outcomes in patients with clear cell RCC. However, there is emerging data that CRP is a useful biomarker for both RCC-specific mortality as well as overall mortality. We hypothesize the addition of CRP to current nomograms will enhance predictive power in patients undergoing nephrectomy. METHODS A retrospective review was conducted of patients who underwent nephrectomy at our institution from 2005 to 2012. Pre-operative CRP levels were drawn at initial consultation and postoperative CRP levels were drawn between 1 and 4 months postoperatively. Multivariable Cox proportional hazard (Cox) regression and competing risks regression (CRR) model including all traditionally recorded variables such as stage, grade, and presence of metastatic disease was constructed to calculate overall mortality (OM) and RCC-specific mortality (RCC-SM) respectively from these models. Death from other causes were considered as competing risks of RCC-SM. RESULTS A total of 516 patients were included this study with a mean follow-up of 1.7 ± 1.4 years. The 1 and 3 year RCC-specific mortality was 8.8% and 13.5%, respectively. Four nomograms were generated using overall mortality and RCC-specific mortality as endpoints, two for preoperative counseling and two for postoperative counseling. The factor with the largest effect on all nomograms was pre-operative CRP. Based on the internal validation with bootstrap, the concordance indices for RCC-specific mortality in the pre-operative nomogram, post-operative nomogram and SSIGN were 0.88, 0.90, and 0.83, respectively (P = 0.005 or 0.001 comparing with SSIGN for pre-op or postop nomograms). For overall mortality the pre-operative nomogram, post-operative nomogram, and SSIGN score demonstrated concordance indices of 0.86, 0.91, and 0.82, respectively (P = 0.123 or 0.003 comparing with SSIGN for pre-op or postop nomograms). CONCLUSIONS We have generated nomograms incorporating CRP that effectively predict overall and RCC-specific mortality. Our concordance index is superior to existing methods, but must externally validated. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e306 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Metrics Author Information Wayland Hsiao Atlanta, GA More articles by this author Lindsey Herrel Atlanta, GA More articles by this author Changhong Yu Cleveland, OH More articles by this author Michael Kattan Cleveland, OH More articles by this author Kenneth Ogan Atlanta, GA More articles by this author Daniel Canter Atlanta, GA More articles by this author John Pattaras Atlanta, GA More articles by this author Peter Nieh Atlanta, GA More articles by this author Wayne Harris Atlanta, GA More articles by this author Bradley Carthon Atlanta, GA More articles by this author Omer Kucuk Atlanta, GA More articles by this author Viraj Master Atlanta, GA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...