C-reactive protein: A biomarker of survival in patients with metastatic renal cell carcinoma treated with subcutaneous interleukin-2 based immunotherapy
C-reactive protein: A biomarker of survival in patients with metastatic renal cell carcinoma treated with subcutaneous interleukin-2 based immunotherapy
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DOI：
10.1097/01.ju.0000146713.50673.e5
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发表时间：
2005-01-01
影响因子：
6.6
通讯作者：
Guida, M
中科院分区：
文献类型：
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作者：
Casamassima, A;Picciariello, M;Guida, M
目的：在接受低剂量基于白细胞介素-2的皮下免疫治疗的转移性肾癌患者中，我们在治疗前评估了一组生物体液和临床参数，以验证它们与临床结果的相关性。材料和方法：我们分析了我院收治的110例患者的记录。治疗前分析总淋巴细胞、乳酸脱氢酶、红细胞沉降率、白蛋白、c反应蛋白（CRP）、纤维蛋白原与临床参数的相关性，包括身体状况、患者年龄、性别、既往肾切除术、病变数量及部位、肾切除术至转移期无病间隔（DFI）。结果：中位生存期为12个月（部分和完全缓解33个月，病情稳定14个月，进展7个月）。部分和完全缓解的总缓解率为24%，疾病稳定的为37%，进展的为39%。在单因素分析中，良好的表现状态（p = 0.0000）、既往肾切除术（p = 0.0001）、DFI超过12个月（p = 0.0003）、骨病部位（p = 0.0013）、低转移部位（p = 0.0449）、正常白蛋白（p = 0.0001）、低/正常纤维蛋白原（p = 0.0140）、低/正常乳酸脱氢酶（p = 0.0430）和低/正常CRP （p = 0.0000）与较好的生存率相关。在最终的多变量分析中，仅发现CRP （p = 0.002）和DFI （p = 0.0497）在生存率中具有独立作用。当我们将临床和生物体液因素联系起来时，只有CRP与DFI （p = 0.021）和既往肾切除术（p = 0.041）相关。结论：我们的数据证实，一些临床和生物体液因素可能与转移性肾细胞癌的生存密切相关。从这项研究中出现的一个有趣的新方面是CRP和纤维蛋白原的预后价值，它们能够区分预后好坏。
Purpose: In patients with metastatic renal cell carcinoma treated with low dose subcutaneous interleukin-2 based immunotherapy we evaluated a panel of biohumoral and clinical parameters before treatment to verify their correlation with clinical outcome.Materials and Methods: We analyzed the records of 110 patients treated at our institution. Before treatment total lymphocytes, lactate dehydrogenase, the erythrocyte sedimentation rate, albumin, C-reactive protein (CRP) and fibrinogen were analyzed and correlated with clinical parameters, namely performance status, patient age, sex, prior nephrectomy, number and sites of disease, and disease-free interval (DFI) from nephrectomy to metastatic disease.Results: Median survival was 12 months (partial and complete response 33, stable disease 14 and progression 7). The overall response was 24% for a partial and complete response, 37% for stable disease and 39% for progression. On univariate analysis good performance status (p = 0.0000), prior nephrectomy (p = 0.0001), DFI longer than 12 months (p = 0.0003), bone disease site (p = 0.0013), a low number of metastatic sites (p = 0.0449), normal albumin (p = 0.0001), low/normal fibrinogen (p = 0.0140), low/normal lactate dehydrogenase (p = 0.0430) and low/normal CRP (p = 0.0000) were related to better survival. On final multivariate analysis only CRP (p = 0.002) and DFI (p = 0.0497) were found to have an independent role in survival. When we correlated clinical and biohumoral factors, only CRP correlated with DFI (p = 0.021) and prior nephrectomy (p = 0.041).Conclusions: Our data confirm that some clinical and biohumoral factors may be strongly related to survival in metastatic renal cell carcinoma. The interesting new aspect emerging from this study is the prognostic value of CRP and fibrinogen, which are able to discriminate a good from a poor prognosis.