Increased Expression of Intratumoral C-Reactive Protein Predicts Mortality in Patients with Localized Clear Cell Renal Cell Carcinoma.
Sarfraz Ali, Viraj A Master, Ammara Abbasi, Omer Kucuk, Andrew N Young, Kenneth Ogan, John G Pattaras, Peter T Nieh, Fray F Marshall, Adeboye O Osunkoya. Emory University School of Medicine, Atlanta, GA
Background: C-reactive protein (CRP) is an acute phase reactant typically produced in the liver following stimulation by interleukin-6. Serum CRP has recently been shown in some studies, to be a potential predictor of outcome in patients with localized and metastatic renal cell carcinoma (RCC). However, the prognostic significance of intratumoral CRP expression with emphasis on clinical outcome in patients with RCC remains unknown.
Design: 102 patients with fully resected, clinically localized (pT1-T3N0M0) clear cell RCC were followed postoperatively. Intratumoral CRP expression was assessed in radical nephrectomy specimens using immunohistochemical analysis. Patients were categorized by intratumoral CRP expression as follows: negative, 0; weak, 1+, moderate, 2+; strong, 3+. Univariate, Kaplan-Meier, and multivariate Cox regression analyses examined overall survival (OS) across patient and disease characteristics. Variables examined in multivariate Cox regression analysis included: pT-Stage and Fuhrman nuclear grade; tumor size; UCLA Integrated Staging System (UISS); Mayo Clinic stage, size, grade, and necrosis (SSIGN) score; Kattan normogram; preoperative serum CRP, and intratumoral CRP expression.
Results: Follow-up ranged from 19 to 42 months, with a mean (SD) of 29.8 (6.0) months. During this follow-up, 19/102 patients (19%) died of disease. Of all tumors, 30%, 43%, and 27% were graded as 0, 1-2+, and 3+ for intratumoral CRP expression, respectively. Of these patients, 7%, 14%, and 41% died of disease, respectively. Mean (SD) survival for these groups was 24.5 (3.5), 16.7 (2.7), and 7.5 (1.2) months, respectively (p=0.001). After controlling for variables significant in univariate analysis, patients with staining intensity of 1+ to 2+ and 3+ experienced a 3.5-fold (HR: 3.492, 95% CI: 0.413-29.505, p=0.251) and 22-fold (HR: 22.661, 95% CI: 2.171-246.558, p=0.009) increased risk of mortality, respectively, compared to patients with intratumoral CRP expression of 0.
Conclusions: To our knowledge, this is the first study to correlate intratumoral CRP expression with clinical outcome data. Increased expression of intratumoral CRP represents a significant prognostic measure of mortality in patients with localized clear cell RCC.
Category: Genitourinary (including renal tumors)
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 107, Wednesday Morning