MP24-04: C-reactive Protein and risk of Major Complications and Mortality Outcomes in patients undergoing surgery for Renal Cell Carcinoma

John Perry*, La Jolla, CA, Hajime Tanaka, Tokyo, Japan, Arman Walia, Ava Saidian, Rekha Narasimhan, Mimi Nguyen, Madison Chakoumakos, Margaret Meagher, Juan Javier-Desloges, La Jolla, CA, Kazutaka Saito, Yasuhisa Fujii, Tokyo, Japan, Ithaar Derweesh, La Jolla, CA

Introduction: C-reactive protein (CRP) has been demonstrated to be an independent predictor of survival outcomes in renal cell carcinoma (RCC). The use of biomarkers to predict post-surgical complications is not well studied. We sought to investigate predictive factors for major complications following surgery for RCC and delineate impact on mortality outcomes.

Methods: We performed a two-center retrospective analysis of patients who underwent partial (PN) and radical nephrectomy (RN) for RCC. Patients who had complications within 30 days after surgery were identified and the complications were scored using Clavien-Dindo classification system. Patients were categorized into groups based on whether or not they experienced 30-day major complications (Clavien =3). Primary outcome was non-cancer mortality (NCM), with secondary outcomes being all-cause (ACM) and cancer-specific (CSM) mortality. Multivariable analyses (MVA) were conducted to evaluate predictors for Clavien =3 complications and non-cancer mortality (NCM).

Results: A total of 2729 patients were analyzed [149 (5.5%) experienced Clavien =3 complications; median follow up 35 months]. When patients who experienced Clavien =3 complications were compared to those who did not, no differences were noted in age (p=0.647), diabetes mellitus (p=0.647), and tumor size (p=0.789). MVA revealed that elevated CRP (OR 2.1, p=0.005), PN (OR 2.4, p=0.002), and open surgical approach (OR 2.0, p=0.01) were both predictive of Clavien =3 complications. Additionally, MVA demonstrated that elevated CRP was an independent predictor of NCM (HR 2.1, p=0.035), CSM (HR 6.0, p<0.001) and ACM (HR 3.7, p<0.001), while presence of 30-day Clavien =3 complications was independently associated with worsened NCM (HR 3.6, p=0.006) and ACM (HR 2.1, p=0.026), but not CSM (HR 1.4, p=0.484).

Conclusions: Elevated CRP was a predictor for development of 30-day Clavien =3 complications, which development of was independently associated with worsened all-cause and non-cancer mortality in patients undergoing surgery for RCC. Aggressive pursuit of preoperative risk stratification and mitigation strategies for major complications may represent an avenue to further improve survival outcomes in surgically managed RCC patients.

Source of Funding: Stephen K Weissman Kidney Cancer Research Fund