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On the other hand, surgical The Latest Navitoclax Is Twice The Fun interventions, including cytoreductive nephrectomy and or metastasectomy, have also proven to be beneficial to some extent for patients with AM RCC, in terms of both survival and quality of life. Surgical removal of the majority of tumor burden can be expected to diminish the source of tumor promoting growth factors or immunosuppressive cytokines, although this has not yet been confirmed. Currently, an important concern is that no consensus has been established on the criteria for identifying patients with AM RCC who are most likely to benefit from nephrectomy and or metastasectomy performed at the onset. C reactive protein is an acute phase reactant protein exclusively synthesized by hepatocytes.

The serum concentration of CRP rises as much as 1000 fold in immediate response to cytokines or chemical media tors released in various pathological conditions, includ ing acute inflammation, infection, tissue or cell necrosis, and some malignancies. Several studies have reported that CRP is a useful serum marker for patients with RCC, and elevated serum CRP levels have been shown to be associated with tumor aggressiveness, recurrence, and poor prognosis. However, its clinical utility in AM RCC, particularly in deciding whether to perform surgical interventions at the onset, has not been studied well. We retrospectively investigated the role of CRP as a prog nostic marker for patients with AM RCC. We also explored its usefulness in identifying patients who are most likely to benefit from early nephrectomy.

Methods Patients and treatment Eligibility for the study was defined as the presence of clinical or pathologic T4, nodal or organ metastatic RCC when the condition was first diagnosed. A total of 181 patients who were treated at our hospitals for AM RCC between April 1989 and June 2009 were enrolled in the study. The study was conducted in accordance with the principles espoused by the Declaration of Helsinki and all local regulations. The study protocol was approved by the institutional ethics committee of the Yokohama City University Hospital. Among 181 AM RCC patients, 18 patients underwent potentially curative surgeries, i. e, radical nephrectomy concomitant with adjacent organ resection and or total metastasect omy. On the other hand, 111 patients underwent cytoreductive nephrectomy, while the remaining 52 did not undergo nephrectomy and received only medical treatment.

Further, 120 of the 129 patients who underwent any kind of nephrectomy also received postoperative im munotherapy, including IFN and or IL 2. Among the 52 patients who did not undergo nephrectomy, 42 received immunotherapies. Molecular targeting agents, in cluding sorafenib, sunitinib, and or everolimus, were administered to 7 patients after 2008.