Presentation Authors: Masahiro Toide*, Kazutaka Saito, Yosuke Yasuda, Kenji Tanabe, Shohei Fukuda, Hiroshi Fukushima, Minato Yokoyama, Junichiro Ishioka, Yoh Matsuoka, Tokyo, Japan, Dattataya Patil, Atlanta, GA, Brittney Cotta, Sunil Patel, San Diego, CA, Viraj Master, Atlanta, GA, Ithaar Derweesh, San Diego, CA, Yasuhisa Fujii, Tokyo, Japan
Introduction: Papillary renal cell carcinoma (papRCC) is the second most common subtype of RCC, nonetheless, prognostic significance of clinical parameters in patients with papRCC is still controversial. C-reactive protein (CRP) is a potential biomarker for clear cell RCC (Saito K, Nat Rev Urol, 2011; Johnson TV, Urology, 2010), however, associations of CRP and prognosis for papRCC have not been investigated. We evaluated the prognostic impact of CRP for patients with surgically treated non-metastatic papRCC in the international multi-racial series.
Methods: We established international multi-racial dataset (Tokyo Medical and Dental University, Japan; University of California San Diego, CA; Emory University, GA) of surgically treated 3799 RCC patients. Of these patients, 400 patients with non-metastatic papRCC were enrolled for analysis. Variables including pathological T stage (pT stage), race, age, sex, type of surgery and CRP were evaluated. The elevation of pretreatment CRP was defined as a level of more than 10 mg/ L. Primary endpoint was recurrence-free survival (RFS), which was estimated using Kaplan-Meier method. Associations of RFS with clinical covariates were investigated by using Cox proportional hazard model.
Results: Enrolled 400 patients included 50 Asian, 155 Caucasian, 174 African-American, and 21 other racial patients. The patients for each pT stage (pT1/2/3/4) were 313/46/32/3. The elevations of pretreatment CRP were found in 48 patients (12%). During the follow up period (median 16 months), 30 patients (8%) had recurrences. RFS rates for the entire cohort were 95% at 1 year, 91% at 3 years and 87% at 5 years, respectively. In multivariate analysis, pretreatment CRP was a significant prognostic factor for RFS as well as pT stage. RFS rates were significantly worse in patients with elevated CRP (hazard ratio 2.47, 95% confidence interval 1.03-5.48; p=0.043). The 3 year RFS rates of the patients with elevated CRP (76%) was significantly worse than that of patients without elevated CRP (93%)(p = 0.0012; Figure).
Conclusions: CRP is a significant prognostic factor in patients with non-metastatic papRCC in the international multi-racial database.