UroToday - The presence of a systemic inflammatory reaction, represented by C-reactive protein (CRP), has been recognized as one of the negative prognostic factors in various malignancies. In genitourinary cancers our group and others have demonstrated that an increase in pretreatment CRP is a negative prognostic factor in patients with renal cell carcinoma 1-4 as well as in those with upper urinary tract urothelial carcinoma.5 Pretreatment CRP status has also been shown to be prognostic in patients with metastatic renal cell carcinoma (mRCC).6,7 Recently we demonstrated that normalization of CRP is associated with favorable outcome in patients with muscle invasive bladder cancer receiving chemoradiotherapy, indicating that CRP kinetics would reflect the aggressiveness of the cancer. Since it has not been clear whether CRP kinetics could predict the outcome of mRCC we investigated the prognostic impact of CRP kinetics in patients undergoing cytoreductive nephrectomy for mRCC.

We explored the prognostic impact of CRP status in 40 patients with undergoing cytoreductive nephrectomy. CRP decreased to normal after cytoreductive nephrectomy in 74% of patients whose CRP was increased before surgery. Interestingly no significant difference was found in terms of overall survival rate between patients whose preoperative CRP level was not elevated and those in whom preoperative CRP was increased but normalized postoperatively. Failure of CRP normalization after cytoreductive nephrectomy indicates extremely poor prognosis indicating that not only preoperative CRP but also CRP kinetics are prognostic in these patients.

The number and site of metastases that might reflect total tumor burden after cytoreductive nephrectomy were not different between patients with and those without CRP normalization.

The current results were obtained from patients in the era of immunotherapy. Further study of patients in the present era of targeted treatments is needed. CRP is a routinely usable marker, and CRP level is a useful adjunct that can be associated in routine evaluation in patients with mRCC.

References

1. Komai Y, Saito K, Sakai K et al: Increased preoperative serum C-reactive protein level predicts a poor prognosis in patients with localized renal cell carcinoma. BJU Int 2007; 99: 77.
2. Lamb GW, McMillan DC, Ramsey S et al: The relationship between the preoperative systemic inflammatory response and cancer-specific survival in patients undergoing potentially curative resection for renal clear cell cancer. Br J Cancer 2006; 94: 781.
3. Ito K, Asano T, Yoshii H et al: Impact of thrombocytosis and C-reactive protein elevation on the prognosis for patients with renal cell carcinoma. Int J Urol 2006; 13: 1365.
4. Karakiewicz PI, Hutterer GC, Trinh QD et al: C-reactive protein is an informative predictor of renal cell carcinoma-specific mortality: a European study of 313 patients. Cancer 2007; 110: 1241.
5. Saito K, Kawakami S, Ohtsuka Y et al: The impact of preoperative serum C-reactive protein on the prognosis of patients with upper urinary tract urothelial carcinoma treated surgically. BJU Int 2007; 100: 269.
6. Casamassima A, Picciariello M, Quaranta M et al: C-reactive protein: a biomarker of survival in patients with metastatic renal cell carcinoma treated with subcutaneous interleukin-2 based immunotherapy. J Urol 2005; 173: 52.
7. Ramsey S, Lamb GW, Aitchison M et al: Evaluation of an inflammation-based prognostic score in patients with metastatic renal cancer. Cancer 2007; 109: 205.
8. Yoshida S, Saito K, Koga F et al: C-reactive protein level predicts prognosis in patients with muscle-invasive bladder cancer treated with chemotherapy. BJU Int 2008; 101:978.

Manabu Tatokoro, MD, and Kazutaka Saito, MD, PhD, as part of Beyond the Abstract on UroToday.

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