As reported previously, nephrectomy provided strong survival advantage for AM RCC patients. The median NSC 136476 survival for the 129 patients who underwent nephrec tomy and the 52 patients who did not undergo nephrec tomy was 23. 9 months and 2. 80 months, respectively. C reactive protein and patient survival From the medical records, we collected data regarding CRP levels at the onset in 143 181 AM RCC patients. The patients exhibited varying serum CRP levels, ran ging from undetectable to 212 mg L, and 103 143 patients had abnormal CRP values. We determined the CRP cutoff point by means of ROC analysis for the cohort of patients who under went nephrectomy. From the ROC analysis, we found 2 reasonable CRP cutoff points, 18. 0 and 67. 0 mg L, accordingly, we classified the patients into nor mal mildly elevated CRP, elevated CRP, and highly elevated CRP groups.
Kaplan Meier analyses revealed statistically signifi cant differences between these 3 groups, and the median overall survival periods were 53. 2, 12. 6, and 4. 20 months in the normal mildly elevated CRP, elevated CRP, and highly elevated CRP groups, respectively. We next applied the same CRP cutoff and grouping system to the AM RCC cohort of patients who did not undergo nephrectomy. We found that the 3 CRP levels defined were again correlated with patient survival and that patients with normal mildly elevated CRP levels clearly showed longer survival periods. The median overall survival periods were 24. 4, 2. 83, and 1. 54 months in the normal mildly elevated CRP, elevated CRP, and highly elevated CRP groups, respectively.
Since patients with highly elevated levels of CRP showed poor prognosis despite the treatment procedures, i. e, nephrectomy or medical treatment only, we compared these 2 groups. Kaplan Meier analysis showed that the 2 groups did not differ statistically. Although the 2 groups differed slightly with respect to patient characteristics and backgrounds, the data suggested that initial nephrectomy did not seem to provide substantial survival advantages for patients with highly elevated CRP levels. CRP as an independent prognostic parameter for AM RCC Lastly, we tested the association of patient survival with CRP values against that with other established clinical and biochemical parameters, including the Memorial Sloan Kettering Cancer Center risk factors.
Survival analysis was performed for 81 patients who underwent nephrectomy and for whom the complete clinical and biochemical data were available. Cox univariate analyses demonstrated that several clin icopathologic parameters, including age. ECOG PS. number of metastatic organ sites. and levels of Hb, ALP, and CRP, showed a statistically significant association with OS. On the other hand, neither LDH nor corrected calcium levels were correlated with survival lengths.