Preoperative Elevation Of C-Reactive Protein Is A Predictor For Adverse Oncologic Survival Outcomes For Renal Cell Carcinoma: Analysis From The International Marker Consortium Renal Cancer (Inmarc)

We investigated the association of preoperative C-reactive protein (CRP) with outcomes in renal cell carcinoma (RCC) in a cohort of 2445 patients, and noted that elevated CRP ( 5.0 mg/L) was independently associated with recurrence-free and overall survivals. These findings represent the largest and most diverse cohort presented and suggest incorporation of CRP as a prognostic marker in risk stratification protocols. Background: We sought to analyze the usefulness of pretreatment C-reactive protein (CRP) as a predictor of survival and oncological outcomes in patients with renal cell carcinoma (RCC). Methods: Retrospective international analysis of patients with RCC with pretreatment CRP values from 2006 to 2017. A CRP of more than > 5 mg/L was deemed elevated. The cohort was subdivided into 2 groups for analysis (normal CRP <= 5 mg/L; elevated CRP > 5). Primary outcome was overall survival (OS) and secondary outcome was recurrence-free survival (RFS). Kaplan-Meier analyses (KMA) and multivariable analyses (MVA) were used to delineate survival outcomes and their predictors. Results: We analyzed 2445 patients (1641 male/804 female; normal CRP 1056/elevated CRP 1389; mean follow-up 36 months). Patients with elevated CRP had a higher incidence of hypertension ( P = .001), higher body mass index ( P < .001), and larger tumor size (6.0 cm vs 3.9 cm; P < .001). MVA for RFS demonstrated elevated CRP (hazard ratio [HR], 1.85; P = .005), tumor size (HR, 1.1; P < .001), and high tumor grade (HR, 3.1; P < .001) to be independent risk factors. For normal vs elevated CRP, KMA for RFS of stages 1-4 RCC revealed a 5-year RFS of 93% vs 88% ( P = .001), 95% vs 83% ( P = .163), 84% vs 62% ( P = .001), and 58% vs 60% ( P = .513), respectively. KMA MA KMA for OS of stages 1-4 RCC revealed a 5-year OS of 98% vs 81% ( P = .001), 94% vs 80% ( P = .103), 94% vs 65% ( P = .001), and 99% vs 38% ( P < .001), respectively. Conclusions: Pretreatment CRP was an independent predictor of RFS and OS in an international multicenter cohort of patients with RCC.