Preoperative CRP Predicts Survival in Renal Cell Carcinoma

Kate Johnson

March 27, 2013

MILAN, Italy — Preoperative C-reactive protein (CRP) level is a significant prognostic marker of disease severity and cancer-specific survival in patients undergoing surgical treatment for renal cell carcinoma, according to a German study.

"There are no clinically established prognostic markers for renal cell carcinoma," said lead investigator Sandra Steffens, MD, from the Hannover Medical School in Germany. "CRP is interesting because it's a routine test worldwide and inexpensive to perform."

"However, it has limitations," she acknowledged. "It is a very unspecific marker because it can also be elevated in patients with infections or coronary disease."

Dr. Steffens presented the study results here at the European Association of Urology 28th Annual Congress. First results were published before the meeting in BMC Cancer (2012;12:399).

Dr. Steffens and her team retrospectively evaluated 1161 patients with renal cell carcinoma (mean age, 61.9 years) who underwent renal tumor surgery at 2 medical centers in Germany.

In the study cohort, diagnoses were clear cell (87.1%), papillary (7.6%), chromophobe (2.3%), and nonclassified (3.0%) renal cell carcinoma. Treatment was radical nephrectomy in 75.9% of patients and partial nephrectomy in 24.1%.

Preoperative CRP levels were categorized as low (≤4 mg/L), intermediate (4 to 10 mg/L), or high (>10 mg/L).

After a mean follow-up of 54 months, 24.0% of the patients died from the disease and 4.1% died from other causes.

The investigators found that preoperative CRP levels correlated significantly with tumor stage, risk for nodal disease, risk for distant metastasis, and cancer-specific survival.

Table. Correlation Between Preoperative CRP Level and Outcome

Outcome Low, % Intermediate, % High, % P value
5-year cancer-specific survival 89.4 77.9 49.5 .001
Locally advanced tumors 19.3 30.2 63.2 <.001
Risk for nodal disease 2.1 3.1 16.4 <.001
Distant metastasis 2.9 8.6 30.0 <.001


On multivariate analysis, CRP was found to be an independent prognostic marker of cancer-specific and overall survival, after adjustment for age, sex, tumor differentiation and stage, histology, and nodal and distant metastasis (< .001), Dr. Steffens reported.

In addition, risk of dying was 1.67-fold higher in patients with intermediate CRP levels than in those with low levels, and was 2.48-fold higher in patients with high levels.

"As biomarkers in fluids offer the opportunity for more objective and reproducible measurement prior to tumor surgery, the use of CRP as a well-standardized parameter worldwide should not be underestimated," report Dr. Steffens and colleagues. "Its routine use could allow better risk stratification and risk-adjusted follow-up for patients with kidney cancer."

These findings "are relevant and there are some other studies that have addressed this," said Sabine Brookman-May, a PhD candidate from Ludwig Maximilian University in Munich, Germany, who attended the session.

There is currently a lack of defined markers to guide clinicians in treatment decisions for renal cell carcinoma, she told Medscape Medical News. "It looks at least like it is a significant prognostic marker, and should be assessed when patients are treated."

Dr. Steffens and Ms. Brookman-May have disclosed no relevant financial relationships.

European Association of Urology (EAU) 28th Annual Congress: Abstract 348. Presented March 17, 2013.