Session: MP41: Kidney Cancer: Epidemiology & Evaluation/Staging/Surveillance II
MP41-04: Association of Elevated C-Reactive Protein with Worsened Outcomes in Different Histologies of Renal Cortical Tumors: Analysis of the INMARC Registry
Introduction: There is a growing trend towards exploring the use of C reactive protein (CRP) as a tool capable to predict oncological outcome in patients affected by renal cell carcinoma (RCC). The impact of CRP on the different types of histology has not yet been fully delineated. Primary objective is to evaluate the correlation between CRP and cancer specific survival (CSS). Secondary objective is to evaluate all-cause of mortality (ACM) and recurrence (R). Methods: A retrospective analysis of the International Marker Consortium for Renal Cancer database was performed. Patients were stratified according to their histological report: clear cell carcinoma (ccRCC), chromophobe (chRCC), papillary (pRCC), and variant histology RCC (vhRCC) and according to the CRP level: low <5 mg/L and high>5 mg/L. Kaplan Meier analysis and Cox test of equality were performed stratifying patients according to CRP and histotype to assess differences. Multivariable Cox regression (MVA) was fitted to assess predictors for ACM, CSM, and (R) adjusted for age, ethnicity, tumor grade, CRP and surgery type. Results: 5785 patients were analyzed. Stratified according to the histology we observed the following distributions: 3,831 ccRCC, 346 chRCC, 859 pRCC, 249 vhRCC and 500 benign neoplasms. Proportion of high CRP were as follows: ccRCC 64.8%, pRCC 13.6%, chRCC 5.6%, vhRCC 5.5%, and benign neoplasm 10.3% (p < 0.001). Median follow up time was 48 months (IQR 15-90). MVA for CSM showed that high CRP were at higher risk in ccRCC (HR=4.6; p<0.001), chRCC (HR=4; p<0.02), pRCC (HR=5.3; p<0.01) and vhRCC (HR=3.1; p<0.01). MVA was significant also for ACM: ccRCC (HR=2.4; p<0.01), chRCC (HR=2.2; p<0.003), pRCC (HR=2.8; p<0.001), vhRCC (HR=2.1; p<0.007) and for R: ccRCC (HR=2.7; p<0.001), chRCC(HR=2.2; p<0.01), pRCC(HR=2.3; p<0.009) and vhRCC (HR=4; p<0.001). Comparing low vs high CRP we observed worsened 5 year CSM in ccRCC (RH=2.3; p<0.001) pRCC (RH=2.6; p<0.001), chRCC (RH =1.9; p<0.001) and vhRCC(RH=1.4; p<0.02); worsened 5 year overall survival in ccRCC (RH =1.9;p < 0.001), pRCC (RH =2.3; p<0.001), chRCC (RH=1.7; p<0.001) and vhRCC (RH1.4; p<0.001); worsened R in ccRCC (RH=1.6; p<0.001), pRCC (RH=1.1; p<0.001) and chRCC (RH=1; p<0.001). Conclusions: High CRP is most common in ccRCC and is nonetheless an independent predictor of survival outcomes and R in all histological groups. CRP may thus identify a subgroup of patients at risk for adverse outcomes in which closer follow up or consideration for adjuvant therapy may be of benefit. Further investigation is requisite. SOURCE OF Funding: none
