The Predictive Value of C-reactive Protein for Prognosis in Patients with Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy: A Multi-institutional Study
The Predictive Value of C-reactive Protein for Prognosis in Patients with Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy: A Multi-institutional Study
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DOI：
10.1016/j.eururo.2012.11.050
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发表时间：
2014-01-01
期刊：
影响因子：
23.4
通讯作者：
Oya, Mototsugu
中科院分区：
文献类型：
--
作者：
Tanaka, Nobuyuki;Kikuchi, Eiji;Oya, Mototsugu
背景资料：很少有研究讨论血清C反应蛋白（CRP）水平对上尿路上皮癌（UTUC）预后的影响。目的：探讨根治性肾输尿管切除术（RNU）围手术期CRP水平是否提供额外的预后信息。设计、设置和参与者：共纳入564例来自回顾性多机构队列的UTUC患者。中位随访时间为32 mo.干预：所有患者均接受RNU，无新辅助化疗，而106例（18.8%）接受辅助化疗。结果测量和统计分析：围手术期CRP水平和结果之间的关联进行了评估，采用多变量分析。结果与局限性：术前CRP（pre-CRP）水平升高136例（24.1%）。多变量分析显示，前CRP升高是随后疾病复发的独立预测因子（CRP 0.51-2.00的风险比[HR]：1.47; CRP > 2.00的风险比[HR]：1.89）。前CRP水平2.00 mg/dl的患者5年无复发生存率为69.2%（p < 0.001）。在癌症特异性死亡率中发现了类似的结果，表明CRP前升高是预后不良的独立预测因子（CRP 0.51-2.00的HR：1.74; CRP > 2.00的HR：2.31）。在前CRP升高组的亚组分析中，术后CRP水平恢复正常是预后较好的独立预测因素。本研究的局限性在于其回顾性、异质性患者组和多机构设计导致的可变随访方案。血清CRP可能成为UTUC的一个可能的生物标志物，提示前CRP水平升高的患者可预测随后的疾病复发和癌症特异性死亡率，术后CRP水平恢复正常是预后的独立预测因素。(C)2012年欧洲泌尿外科协会。由Elsevier B出版。V.保留所有权利。
Background: Few studies have discussed the prognostic impact of serum C-reactive protein (CRP) level in upper tract urothelial carcinoma (UTUC).Objective: To investigate whether the perioperative level of CRP provides additional prognostic information following radical nephroureterectomy (RNU).Design, setting, and participants: A total of 564 patients with UTUC from a retrospective multi-institutional cohort were included. The median follow-up was 32 mo.Intervention: All patients underwent RNU without neoadjuvant chemotherapy, while 106 patients (18.8%) received adjuvant chemotherapy.Outcome measurements and statistical analysis: Associations between perioperative CRP level and outcome were assessed using multivariate analysis. A serum CRP level >0.50 mg/dl was defined as elevated.Results and limitations: Preoperative CRP (pre-CRP) level was elevated in 136 patients (24.1%). Multivariate analysis showed that pre-CRP elevation was an independent predictor of subsequent disease recurrence (hazard ratio [HR]: 1.47 for CRP 0.51-2.00; HR: 1.89 for CRP > 2.00). Five-year recurrence-free survival rates were 69.2% in patients with pre-CRP levels 2.00 mg/dl (p < 0.001). Similar results were found in cancer-specific mortality, showing that pre-CRP elevation was an independent predictor of worse outcome (HR: 1.74 for CRP 0.51-2.00; HR: 2.31 for CRP > 2.00). In a subgroup analysis of the elevated pre-CRP group, postoperative normalisation of CRP level was an independent predictor of better outcome. This study is limited by its retrospective nature as well as its heterogeneous group of patients and variable follow-up protocols resulting from the multi-institution design.Conclusions: Serum CRP may become a possible biomarker in UTUC, suggesting that patients with an elevated pre-CRP level could be predicted to have subsequent disease recurrence and cancer-specific mortality, while postoperative normalisation of CRP level was an independent predictor for prognosis. (C) 2012 European Association of Urology. Published by Elsevier B. V. All rights reserved.