Prognostic value of serum C-reactive protein level prior to second-line treatment in intermediate risk metastatic renal cell carcinoma patients
Prognostic value of serum C-reactive protein level prior to second-line treatment in intermediate risk metastatic renal cell carcinoma patients
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DOI：
10.1007/s10147-019-01459-1
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发表时间：
2019-09-01
影响因子：
3.3
通讯作者：
Oya, Mototsugu
中科院分区：
文献类型：
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作者：
Takamatsu, Kimiharu;Mizuno, Ryuichi;Oya, Mototsugu
近年来，随着免疫肿瘤药物和分子靶向治疗的发展，转移性肾细胞癌（mRCC）的后期治疗发生了巨大变化。尽管国际转移性肾细胞癌数据库联盟（International Metastatic Renal Cell Carcinoma Database Consortium， IMDC）模型对二线治疗是有用的，但该模型存在着超过50%的患者被归为中间风险组的问题。本研究的目的是评估二线治疗前血清c反应蛋白（CRP）水平是否可以区分中危组患者。方法回顾性分析82例接受二线分子靶向治疗的中度危险mRCC患者。我们将血清CRP高于0.5 mg/dl的患者归为CRP升高组，因为二线治疗前血清CRP的中位基线水平为0.51 mg/dl。我们评估了二线治疗开始前血清CRP水平对预后的影响，以预测总生存期（OS）。结果：82例患者中有33例（40%）表现出CRP基线水平升高。CRP升高组和非升高组的中位OS分别为11.5 （95% CI 5.4-17.5）和29.4 （95% CI 25.5-33.5）个月（p = 0.001）。血清CRP升高可预测二线治疗中危患者的预后（HR 2.5, 95% CI 1.4 ~ 4.2, p = 0.001）。结论在二线靶向治疗中，终止一线治疗后血清CRP水平可将中度危险组mRCC患者分为两个预后亚组。
Background The later-line treatment of metastatic renal cell carcinoma (mRCC) has been drastically changing by the development of immune-oncology drugs and molecular targeted treatment in recent years. Although the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model is useful for second-line setting, this model has the problem that over 50% patients are classified as intermediate risk group. The aim of this study is to evaluate whether the serum C-reactive protein (CRP) levels prior to second-line treatment could divide intermediate risk group patients. Methods We retrospectively reviewed 82 consequent intermediate-risk mRCC patients who received second-line molecular targeted therapy. We classified patients who had serum CRP higher than 0.5 mg/dl in elevated CRP group because the median baseline serum CRP level before second-line treatment was 0.51 mg/dl. We assessed the prognostic impact of serum CRP levels prior to second-line treatment initiation to predict overall survival (OS). Results Thirty-three out of 82 (40%) patients demonstrated elevated baseline CRP levels. The median OS of elevated and non-elevated CRP group was 11.5 (95% CI 5.4-17.5) and 29.4 (95% CI 25.5-33.5) months, respectively (p = 0.001). The serum CRP elevation could predict prognosis in intermediate risk patients treated with second-line treatment (HR 2.5, 95% CI 1.4-4.2, p = 0.001). Conclusions The serum CRP levels after first-line treatment termination could divide intermediate risk group mRCC patients into two prognostic subgroups in second-line targeted treatment setting.