Inflammatory prognostic markers in clear cell renal cell carcinoma - preoperative C-reactive protein does not improve predictive accuracy
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Inflammatory prognostic markers in clear cell renal cell carcinoma - preoperative C-reactive protein does not improve predictive accuracy. / Bedke, Jens; Chun, Felix; Merseburger, Axel; Scharpf, Marcus; Kasprzyk, Kathrin; Schilling, David; Sievert, Karl-Dietrich; Stenzl, Arnulf; Kruck, Stephan.
In: BJU INT, Vol. 110, No. 11 Pt B, 11 Pt B, 12.2012, p. 771-777.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Inflammatory prognostic markers in clear cell renal cell carcinoma - preoperative C-reactive protein does not improve predictive accuracy
AU - Bedke, Jens
AU - Chun, Felix
AU - Merseburger, Axel
AU - Scharpf, Marcus
AU - Kasprzyk, Kathrin
AU - Schilling, David
AU - Sievert, Karl-Dietrich
AU - Stenzl, Arnulf
AU - Kruck, Stephan
N1 - © 2012 BJU INTERNATIONAL.
PY - 2012/12
Y1 - 2012/12
N2 - UNLABELLED: What's known on the subject? and What does the study add? White blood cell count and C-reactive protein are reliable prognostic RCC Biomarkers.Nevertheless, accepted cut-offs for risk stratifications are missing. Therefore, both parameters were re-evaluated and multivariable analyses revealed an optimal CRP breakpoint at 0.25 mg/dL to be best to stratify patients at risk of cancer-specific mortality. However, this CRP-based prediction added no additional information compared to a clinico-pathological based model.OBJECTIVE: To re-evaluate the prognostic and predictive significance of the preoperative white blood cell (WBC) count and C-reactive protein (CRP) that independently predicts patient prognosis and to determine optimal threshold values for CRP.PATIENTS AND METHODS: From 1996 to 2005, 327 patients with surgery for clear cell renal cell carcinoma were retrospectively evaluated. Cox proportional hazard models were used, adjusted for the effects of tumour stage, size, Fuhrman grade and Karnofsky index, to evaluate the prognostic significance of WBC count and CRP and to identify threshold values. Identified thresholds were correlated with clinicopathological parameters and used to estimate cancer-specific survival. To prove any additional predictive accuracy of the identified threshold it was compared with a clinicopathological base model using the Harrell concordance index (c-index).RESULTS: In univariable analyses WBC count was a significant prognostic marker at a concentration of 9.5/μL (hazard ratio [HR] 1.83) and 11.0/μL (HR 2.09) and supported CRP values of 0.25 mg/dL (HR 6.47, P < 0.001) and 0.5 mg/dL (HR 7.15, P < 0.001) as potential threshold values. If adjusted by the multivariable models WBC count showed no clear breakpoint, but a CRP value of 0.25 mg/dL (HR 2.80, P = 0.027) proved to be optimal. Reduced cancer-specific survival was proved for CRP 0.25 mg/dL (median 69.9 vs 92.3 months). Median follow-up was 57.5 months with 72 (22%) tumour-related deaths. The final model built by the addition of CRP 0.25 mg/dL did not improve predictive accuracy (c-index 0.877) compared with the clinicopathological base model (c-index 0.881) which included TNM stage, grading and Karnofsky index.CONCLUSIONS: Multivariable analyses revealed that an optimal breakpoint of CRP at a value of 0.25 mg/dL was best to stratify patients at risk of cancer-specific mortality, but CRP 0.25 mg/dL added no additional information in the prediction model. Therefore we cannot recommend measuring CRP as the traditional parameters of TNM stage, grading and Karnofsky index are already of high predictive accuracy.
AB - UNLABELLED: What's known on the subject? and What does the study add? White blood cell count and C-reactive protein are reliable prognostic RCC Biomarkers.Nevertheless, accepted cut-offs for risk stratifications are missing. Therefore, both parameters were re-evaluated and multivariable analyses revealed an optimal CRP breakpoint at 0.25 mg/dL to be best to stratify patients at risk of cancer-specific mortality. However, this CRP-based prediction added no additional information compared to a clinico-pathological based model.OBJECTIVE: To re-evaluate the prognostic and predictive significance of the preoperative white blood cell (WBC) count and C-reactive protein (CRP) that independently predicts patient prognosis and to determine optimal threshold values for CRP.PATIENTS AND METHODS: From 1996 to 2005, 327 patients with surgery for clear cell renal cell carcinoma were retrospectively evaluated. Cox proportional hazard models were used, adjusted for the effects of tumour stage, size, Fuhrman grade and Karnofsky index, to evaluate the prognostic significance of WBC count and CRP and to identify threshold values. Identified thresholds were correlated with clinicopathological parameters and used to estimate cancer-specific survival. To prove any additional predictive accuracy of the identified threshold it was compared with a clinicopathological base model using the Harrell concordance index (c-index).RESULTS: In univariable analyses WBC count was a significant prognostic marker at a concentration of 9.5/μL (hazard ratio [HR] 1.83) and 11.0/μL (HR 2.09) and supported CRP values of 0.25 mg/dL (HR 6.47, P < 0.001) and 0.5 mg/dL (HR 7.15, P < 0.001) as potential threshold values. If adjusted by the multivariable models WBC count showed no clear breakpoint, but a CRP value of 0.25 mg/dL (HR 2.80, P = 0.027) proved to be optimal. Reduced cancer-specific survival was proved for CRP 0.25 mg/dL (median 69.9 vs 92.3 months). Median follow-up was 57.5 months with 72 (22%) tumour-related deaths. The final model built by the addition of CRP 0.25 mg/dL did not improve predictive accuracy (c-index 0.877) compared with the clinicopathological base model (c-index 0.881) which included TNM stage, grading and Karnofsky index.CONCLUSIONS: Multivariable analyses revealed that an optimal breakpoint of CRP at a value of 0.25 mg/dL was best to stratify patients at risk of cancer-specific mortality, but CRP 0.25 mg/dL added no additional information in the prediction model. Therefore we cannot recommend measuring CRP as the traditional parameters of TNM stage, grading and Karnofsky index are already of high predictive accuracy.
KW - Adult
KW - Humans
KW - Male
KW - Aged
KW - Female
KW - Middle Aged
KW - Aged, 80 and over
KW - Adolescent
KW - Young Adult
KW - Reproducibility of Results
KW - Predictive Value of Tests
KW - Prognosis
KW - Retrospective Studies
KW - Germany/epidemiology
KW - Preoperative Period
KW - Survival Rate/trends
KW - C-Reactive Protein/metabolism
KW - Carcinoma, Renal Cell/blood/mortality/surgery
KW - Inflammation/blood
KW - Kidney Neoplasms/blood/mortality/surgery
KW - Neoplasm Staging/methods
KW - Adult
KW - Humans
KW - Male
KW - Aged
KW - Female
KW - Middle Aged
KW - Aged, 80 and over
KW - Adolescent
KW - Young Adult
KW - Reproducibility of Results
KW - Predictive Value of Tests
KW - Prognosis
KW - Retrospective Studies
KW - Germany/epidemiology
KW - Preoperative Period
KW - Survival Rate/trends
KW - C-Reactive Protein/metabolism
KW - Carcinoma, Renal Cell/blood/mortality/surgery
KW - Inflammation/blood
KW - Kidney Neoplasms/blood/mortality/surgery
KW - Neoplasm Staging/methods
U2 - 10.1111/j.1464-410X.2012.11642.x
DO - 10.1111/j.1464-410X.2012.11642.x
M3 - SCORING: Journal article
C2 - 23134582
VL - 110
SP - 771
EP - 777
JO - BJU INT
JF - BJU INT
SN - 1464-4096
IS - 11 Pt B
M1 - 11 Pt B
ER -