Inflammatory response markers and survival prediction in patients with renal cell carcinoma

Abstract

Introduction

Many factors influence the clinical course of patients with renal cell carcinoma (RCC). The most commonly used prognostic indicators are TNM stage, tumor size and RCC type. In this study we evaluated the prognostic relevance of albumin and C-reactive protein (CRP), and Glasgow Prognostic scores (GPS), in patients with primary RCC.

Methods

We retrospectively reviewed all patients surgically treated for primary RCC between 1982 and 2018 at Umeå University Hospital. There were 872 patients, 527 males and 345 females. Data on albumin, CRP and GPS points before surgery were extracted, as well as TNM stage, RCC type, tumor grade, tumor size, and primary treatment. The patients were followed for recurrence and death for up to 37.2 years. We used Kaplan-Meier estimators, Cox-proportional hazards models, to assess the relation between potentially prognostic indicators and RCC-specific death, and all-cause mortality.

Results

Of 872 patients, 708 had clear-cell RCC, 114 papillary RCC, 36 chromophobe RCC and 9 undefined RCC type while 5 patients had missing RCC type data. Except that, women had a significantly (p = 0.002) lower proportion of pRCC, no difference in RCC types and levels of albumin and CRP was observed between genders. Albumin, CRP, and GPSs were all univariately associated to RCC survival (p < 0.001). CRP demonstrated the strongest prognostic association (HR 1.67 95% Ci (1.53–1.83, overriding both albumin and GPS in multivariable models. The AUC for CRP was 0.77 (95% CI: 0.74-0.80).

Conclusion

Elevated CRP, low albumin levels, and elevated GPSs were all associated to poor survival in patients with RCC, Only CRP remained independent in multivariate analysis.

Keywords:

• Renal cell carcinoma
• CRP
• albumin levels
• Glasgow prognostic score
• survival
• prognosis

Acknowledgements

The authors thanks nurse Kerstin Almroth for collection of blood samples. We also thanks Björn Tavelin for skilful statistical assistance.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The study was previously supported by grants through regional agreement between Umeå University and Västerbotten County Council on cooperation in the field of Medicine, and the Lions Cancer Research Foundation in Umeå.