Presentation Authors: Sunil Patel*, Margaret meagher, San Diego, CA, Kazutaka Saito, Tokyo, Japan, Dattatraya Patil, Atlanta, GA, Ahmet Bindayi, Ahmed Eldefrawy, Stephen Ryan, Brittney Cotta, Kendrick Yim, Ryan Nasseri, Zach Hamilton, San Diego, CA, Yosuke Yasuda, Yasuhisa Fujii, Tokyo, Japan, Viraj Master, Atlanta, GA, Ithaar Derweesh, San Diego, CA
Introduction: C-reactive protein (CRP) is a systemic inflammatory marker which has been associated with overall survival (OS) in Renal Cell Carcinoma (RCC) patients in Asia. Data supporting utility of CRP as a predictive marker in non-Asian populations are sparse and controversial. We analyzed utility of pre-treatment CRP as a predictor of survival and oncological outcomes in a multicenter cohort of RCC patients.
Methods: Retrospective international 3 center (UC San Diego/Tokyo Medical and Dental/Emory) analysis of patients of patients with RCC with pretreatment CRP values from 2006-2017. CRP >0.5mg/dl was used as threshold for elevation and the cohort was subdivided into two groups for descriptive analysis (normal-CRP â‰¤0.5 normal and elevated-CRP>0.5). Primary outcome was overall survival (OS). Secondary outcome was recurrence-free survival (RFS). Kaplan-Meier (KMA) and multivariable analyses (MVA) were utilized to delineate survival outcomes and their predictors.
Results: Overall 2445 patients were analyzed (1641 Male/804 female, normal-CRP 1056/elevated-CRP 1389; mean follow-up 36 months). Patients with elevated CRP were older (59.2 years vs. 59.9 years, p=0.144) had higher incidence of hypertension (p=0.001) and BMI (p < 0.001) and tumor size (3.9 cm vs. 6.0 cm, p < 0.001). MVA for all-cause mortality demonstrated elevated CRP (OR=12.4, p=0.005), increasing tumor size (OR=1.1, p < 0.001), high tumor grade (OR=2.5, p < 0.001), and radical nephrectomy (OR=1.8, p=0.001) to be independent risk factors. MVA for RFS demonstrated elevated-CRP (OR=1.9, p=0.005), increasing tumor size (OR=1.1, p < 0.001), and high tumor grade (OR=3.1, p < 0.001) to be independent risk factors. For normal vs. elevated CRP, KMA revealed 5-year OS of 98% vs 80% (p=0.001), 94% vs. 80% (p=0.103), and 94% vs. 65% (p=0.001), 99% vs 40% (p < 0.001) for Stages 1, 2, 3, and 4, respectively. KMA revealed 5-year RFS of 94% vs. 86% (p=0.001), 95% vs. 83% (p=0.163), 84% vs. 62% (p=0.001), and 52% vs. 60% (p=0.513) for Stages 1, 2, 3, and 4, respectively.
Conclusions: Pre-treatment CRP was an independent predictor of recurrence free survival and overall survival in an international multicenter cohort of RCC patients. While further confirmation is requisite, our findings suggest incorporation of CRP into nomographic and risk stratification protocols.
Source of Funding: Stephen Weissman Kidney Cancer Research Fund