Postoperative Better Than Preoperative C-reactive Protein at Predicting Outcome After Potentially Curative Nephrectomy for Renal Cell Carcinoma
Postoperative Better Than Preoperative C-reactive Protein at Predicting Outcome After Potentially Curative Nephrectomy for Renal Cell Carcinoma
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DOI：
10.1016/j.urology.2010.01.052
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发表时间：
2010-09-01
期刊：
影响因子：
2.1
通讯作者：
Master, V. A.
中科院分区：
文献类型：
--
作者：
Johnson, T. V.;Abbasi, A.;Master, V. A.
术前C-反应蛋白（CRP）可预测局限性肾细胞癌（RCC）的转移和死亡率。然而，局部肾癌切除后的预测潜力仍不清楚。因此，我们评估的绝对能力，术后CRP预测转移和死亡率作为一个连续variable.METHODS患者与临床本地化（T1-T3 N 0 M0）透明细胞肾细胞癌术后1年随访。通过放射学检查确定转移，通过死亡证明确定死亡率。单变量和多变量二元Logistic回归分析研究了1年无复发生存率（RFS）和总生存率（OS）在患者和疾病characteristics.Results的110例患者在这项研究中，16.4%的发展转移和6.4%死亡。发生和未发生转移的患者的平均（SD）术后CRP分别为69.06（73.55）mg/L和5.27（7.80）mg/L。死亡和未死亡患者的平均（SD）术后CRP分别为89.31（69.51）mg/L和10.88（30.32）mg/L。在多变量分析中，T分期（OR：12.452，95% CI：2.889-53.660）和术后CRP（（B：0.080，SE：0.025; P <0.001）是RFS的显著预测因素。T期（或：11.715; 95%可信区间：1.102-124.519）和术后CRP（B：0.017; SE：0.007; P <0.001）也是OS的显著预测因子。在调整术后CRP后，术前CRP不能预测这些outcome.Conclusions术后而非术前CRP是局部RCC肾切除术后转移和死亡的更好预测因子。临床医生应考虑绝对术后CRP，以确定高风险患者进行密切监测或额外治疗。预测算法应考虑将术后CRP作为一个连续变量，以最大限度地提高预测能力。泌尿学76：766.e1-766.e5，2010年。(C)2010年爱思唯尔公司
OBJECTIVES Preoperative C-reactive protein (CRP) predicts metastasis and mortality in localized renal cell carcinoma (RCC). However, the predictive potential of after resection of localized RCC remains unclear. Therefore, we assessed the absolute ability of postoperative CRP to predict metastases and mortality as a continuous variable.METHODS Patients with clinically localized (T1-T3N0M0) clear-cell RCC were followed for 1 year postoperatively. Metastases were identified radiologically and mortality by death certificate. Univariate and multivariate binary logistic regression analyses examined 1 year relapse-free survival (RFS) and overall survival (OS) across patient and disease characteristics.RESULTS Of the 110 patients in this study, 16.4% developed metastases and 6.4% died. Mean (SD) postoperative CRP for patients who did and did not develop metastases were 69.06 (73.55) mg/L and 5.27 (7.80), respectively. Mean (SD) postoperative CRP for patients who did and did not die were 89.31 (69.51) mg/L and 10.88 (30.32), respectively. In multivariate analysis, T-stage (OR: 12.452, 95% CI: 2.889-53.660) and postoperative CRP ((B:.080, SE:.025; P < .001) were significant predictors of RFS. T-Stage (OR: 11.715; 95% CI: 1.102-124.519) and postoperative CRP (B: .017; SE: .007; P < .001) were also significant predictors of OS. After adjusting for postoperative CRP, preoperative CRP was not predictive of these outcomes.CONCLUSIONS Postoperative, not preoperative, CRP is the better predictor of metastasis and mortality following nephrectomy for localized RCC. Clinicians should consider absolute postoperative CRP to identify high-risk patients for closer surveillance or additional therapy. Predictive algorithms should consider incorporating postoperative CRP as a continuous variable to maximize predictive ability. UROLOGY 76: 766.e1-766.e5, 2010. (C) 2010 Elsevier Inc.