Expression of CRP and COX-2 in Clear Cell Renal Cell Carcinoma: Correlation with Pathological Parameters in 110 Patients
S Ali, AN Young, TV Johnson, Q Yin-Goen, NA Johnson, W Harris, VA Master, AO Osunkoya. Emory University School of Medicine, Atlanta, GA
Background: Clear cell renal cell carcinoma (CCRCC) represents greater than 70% of all primary malignant renal neoplasms in adults. C-reactive protein (CRP) is an acute phase reactant that is produced in response to cytokines such as IL-6. It is known that increased plasma IL-6 levels induce increased hepatic and intratumoral production of CRP. Cyclooxygenase enzyme-2 (COX-2) is induced by various stimuli, including inflammation, various growth factors, and cytokines produced by tumor cells. Expression of these two markers has not been well studied in CCRCC. The objective of this study is to correlate the expression of CRP and COX-2 in CCRCC with pathologic parameters.
Design: A search of the surgical pathology and expert consultation files at our institution was performed for nephrectomy specimens with CCRCC from 2007 to 2008. A representative section of the tumor in each case was obtained. Immunohistochemical stains for CRP and COX-2 were performed. Staining intensity was graded as 0, 1+, 2+ and 3+. The staining intensity was then correlated with pathologic stage and Fuhrman nuclear grade for each case.
Results: A total of 110 cases were identified. There was a 2:1 male to female predominance, with 73 male patients (66%) and 37 female patients (34%). Mean patient age was 61 years (range 33-89 years). Pathologic stage was as follows: stage 1-66 patients (60%), stage 2 - 9 patients (8%), stage 3 - 30 patients (27%) and stage 4 - 5 patients (5%). Fuhrman nuclear grade was as follows: grade 1 - 4 patients (4%), grade 2 - 40 patients (40%), grade 3 - 53 patients (48%) and grade 4 - 12 patients (11%). Strong expression of CRP was associated with higher Fuhrman nuclear grade and pathologic stage, and the strength of correlation was statistically significant (p = 0.01 and p= 0.001) respectively. However, COX-2 expression did not show statistically significant correlation with both pathologic stage and Fuhrman nuclear grade (p = 0.1 and p = 0.15) respectively.
Conclusions: There is a statistically significant increase in CRP expression in CCRCC with higher Fuhrman nuclear grade and pathologic stage. In our series, there was no statistically significant correlation between COX-2 expression and Fuhrman nuclear grade or pathologic stage. To our knowledge, this is the largest study correlating the expression of both CRP and COX-2 in tissue with pathologic parameters in patients with CCRCC, which could have significant prognostic and therapeutic implications.
Category: Genitourinary (including renal tumors)
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 114, Monday Morning