Die prognostische Wertigkeit des präoperativen C-reaktiven Proteins im Serum von Patienten mit Nierenzellkarzinom
Rudolph, Raphael Alexander Georg
Aim of the study was the identification of independent predictors of tumorspecific survival in patients with renal cell cancer. The prognostic value of preoperative c-reactive protein was of special interest. Data of 1161 patients of two german centers who had undergone nephrectomy or nephron-sparing surgery in 1995 to 2010 were acquired. The mean follow-up time was 54.2 months. The CRP-value, stratified to three subgroups (CRP LESS-THAN OR EQUAL TO; 4mg/l, 4-10 mg/l and > 10 mg/l), was tested for dependency of age, sex, histology, side, TNM-classification and grading. We found significant univariate correlations of high preoperative CRP-values > 10 mg/l with age (p = 0.005), clear cell histology (p = 0.004), T-staging (p < 0.001), positive lymph node status (p < 0.001), positive organ metastasis status (p < 0.001) and progressed disease (p < 0.001). The 5-year cancer specific survival rates for CRP LESS-THAN OR EQUAL TO 4mg/l, 4-10 mg/l and > 10 mg/l were 89.4, 77.9, and 49.5 %, respectively (p < 0.001). Locally progressed tumors (pT3-pT4) and tumors in progressed disease (pT3-4 and/or N1 and/or M1) had higher absolute CRP-values (p < 0.001; p < 0.001). In patients with a progressed disease even a CRP-value > 4 mg/l indicated a poorer prognosis (p < 0.001). Multivariate analysis identified age (p < 0.001), posivitve lymph node status (HR 3.59; p < 0.001), positive organ metastasis status (HR 3.23; p < 0.001), grading Tumordifferenzierung (p = 0.02) and preoperative CRP (p < 0.001) as independent prognosticators for cancer specific survival. Patients with a CRP of 4-10 and >10 mg/l had a 1.67 and 2.48 fold higher risk of dying due to their tumor compared to those with a pre-operative CRP LESS-THAN OR EQUAL TO 4mg/l, respectively.
Subject HeadingsC-reaktives Protein [GND]
C-reactive protein [MeSH]