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C-reactive protein kinetics to predict recurrence of high-risk renal cell carcinoma after radical surgery

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Abstract

Background

With new options in adjuvant settings, clinical biomarkers to predict recurrence after radical surgery for high-risk renal cell carcinoma (hrRCC) are in need but are scarcely investigated. We aimed to verify the predictive value of perioperative C-reactive protein (CRP) kinetics on hrRCC recurrence.

Methods

We retrospectively evaluated 154 patients who underwent radical surgery for hrRCC (≥ pT3 and/or N1-2 and M0) at two institutions. Patients were classified into Normal (< 0.5) and High (≥ 0.5) according to their preoperative serum CRP (mg/dL). The High group were further classified into Normalized (< 0.5 at post) or Non-normalized (≥ 0.5 at post), and recurrence-free survival (RFS) was compared between groups. Factors for RFS were further analysed, and Harrell’s concordance index (C-index) for the accuracy of predicting RFS was compared with and without the addition of CRP-related variables to pre-existing models.

Results

The RFS was significantly shorter in the High (n = 72, 46.8%) compared to the Normal (n = 82, 53.2%) group (9.7 vs. 66.7 months, p < 0.001). Within the High group, Non-normalized (n = 27, 17.5%) patients showed a significantly shorter RFS compared to the Normalized (n = 45, 29.2%) group (6.2 vs. 20.3, p = 0.009). In the multivariable stepwise analysis, CRP kinetics (hazard ratio 2.15, p = 0.029) effectively predicted RFS while baseline CRP fell short of significance. Higher C-index improvement was observed with CRP non-normalization than the baseline value when added to factors in the Karakiewicz and University of California Los Angeles Integrated Staging System models.

Conclusions

CRP kinetics effectively predicted RCC recurrence after surgery and may aid in decision-making for adjuvant systemic therapy.

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Acknowledgements

We would like to thank Ms. Nobuko Hata (Department of Urology, Tokyo Women’s Medical University) for her secretarial work.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Urology, Tokyo Women’s Medical University Adachi Medical Center, 4-33-1 Kouhoku, Adachi-ku, Tokyo, 123-8558, Japan

    Yudai Ishiyama, Tsunenori Kondo & Hiroki Ishihara

  2. Department of Urology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan

    Yudai Ishiyama, Kazuhiko Yoshida, Junpei Iizuka, Kazunari Tanabe & Toshio Takagi

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  1. Yudai Ishiyama
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  2. Tsunenori Kondo
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  3. Hiroki Ishihara
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  4. Kazuhiko Yoshida
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  5. Junpei Iizuka
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Correspondence to Tsunenori Kondo.

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Conflict of interest

Tsunenori Kondo received honoraria from Pfizer, Takeda, MSD, and Ono Pharmaceutical. Toshio Takagi received honoraria from Ono Pharmaceutical. All other authors have no conflicts of interest to declare.

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Ishiyama, Y., Kondo, T., Ishihara, H. et al. C-reactive protein kinetics to predict recurrence of high-risk renal cell carcinoma after radical surgery. Int J Clin Oncol 27, 969–976 (2022). https://doi.org/10.1007/s10147-022-02136-6

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  • DOI: https://doi.org/10.1007/s10147-022-02136-6

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