C-reactive protein-albumin ratio as a prognostic factor in renal cell carcinoma – A data from multi-institutional study in Japan

Abstract Background: There are a mass of studies declared the prognostic significance of C-reactive protein/albumin ratio (CRP/Alb) in renal cell carcinoma (RCC). Nevertheless, these works are controversial. In our study, we investigate the expression of CRP/Alb in RCC and its role in prognosis and clinicopathological features. Methods: The PubMed, Embase and Cochrane databases were searched systematically for correlative articles published before August 1, 2019. Hazard ratios (HRs) and 95% confidence intervals (CIs) were determined according to eligible studies. And we use fixed and random effects models to calculate on the basis of heterogeneity. Results: Six relevant studies were identified in this study, 1959 participants included in total. Our results showed that CRP/Alb was related to poor overall survival (HR=1.86, 95% CI: 1.56-2.21). In addition, CRP/Alb was also associated with tumor stage (OR=3.29, 95% CI: 1.66-6.50), lymph node involvement (OR=3.76, 95% CI: 2.57-5.51), metastasis (OR=5.69, 95% CI: 2.40-13.51), Fuhrman nuclear grade (OR=4.21, 95% CI: 3.14-5.64), pTNM (OR=4.34, 95% CI: 1.94-9.70) and tumor size (WMD=2.26, 95% CI: 1.86–2.67). However, CRP/Alb was not associated with necrosis. Conclusion: Our study illustrates that the higher CRP/Alb expression was correlated with poorer prognosis and more advanced clinicopathological features in RCC patients. High CRP/Alb expression may act as a valuable predictive biomarker for poor prognosis in RCC patients.

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Preoperative C-reactive protein/albumin ratio predicts outcome of surgical papillary renal cell carcinoma

Future Oncology ◽

10.2217/fon-2018-0611 ◽

2019 ◽

Vol 15 (13) ◽

pp. 1459-1468 ◽

Cited By ~ 2

Author(s):

Jie Gao ◽

Sezim Agizamhan ◽

Xiaozhi Zhao ◽

Bo Jiang ◽

Haixiang Qin ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Papillary Renal Cell Carcinoma ◽

C Reactive Protein ◽

Albumin Ratio ◽

Reactive Protein

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C-reactive protein to albumin ratio predicts the outcome in renal cell carcinoma: A meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0224266 ◽

2019 ◽

Vol 14 (10) ◽

pp. e0224266 ◽

Cited By ~ 4

Author(s):

Wei Zhou ◽

Guang-lin Zhang

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Meta Analysis ◽

C Reactive Protein ◽

Albumin Ratio ◽

Reactive Protein

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C-reactive protein kinetics superior to radiographic response as a surrogate endpoint for survival in patients with advanced renal cell carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.333 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 333-333

Author(s):

M. Tatokoro ◽

K. Saito ◽

Y. Fujii ◽

Y. Komai ◽

F. Koga ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Prognostic Factor ◽

Cell Carcinoma ◽

Renal Cell ◽

Objective Response ◽

Surrogate Endpoint ◽

Advanced Renal Cell Carcinoma ◽

C Reactive Protein ◽

Reactive Protein ◽

Radiographic Response

333 Background: As cytokines and targeted agents against advanced renal cell carcinoma (aRCC) are considered to achieve high stable disease (SD) rate rather than objective response (OR) by radiographic measurement, we often face the therapeutic dilemma in deciding whether to continue the ongoing treatment and when to change it. Therefore, other valid surrogate endpoints have been desired. We have previously demonstrated C-reactive protein (CRP) kinetics could predict prognosis of pts with aRCC (Eur Urol. 2009:1145-53). Methods: This study was performed on 56 pts with aRCC (metastatic: 54, unresectable: 2) enrolled in a phase II trial of interferon-alpha, cimetidine, COX-2 inhibitor and renin-angiotensin-system inhibitor (I-CCA; Cancer Sci. in press). CRP levels were measured at pretreatment, thereafter almost every visit. Pts were divided into 3 groups according to CRP kinetics. Pts whose pretreatment CRP levels were < 5 mg/l were assigned to nonelevated group. Pts whose pretreatment CRP levels were > 5 mg/l but normalized (< 5 mg/l) at least one time during I-CCA were assigned to normalized group. Pts whose CRP level never decreased to normal level were assigned to non-normalized group. Radiographic response was assessed by WHO criteria; survivals were estimated by Kaplan–Meier method and prognostic factors were assessed by Cox's proportional hazard model. Results: Median follow-up was 26 mo. An OR and clinical benefit rate to I-CCA were 20 and 64%, respectively. The median progression-free and overall survival (OS) was 12 and 45 mo, respectively. The median OS was 74, 83 and 13 mo in in non-elevated (n=26), normalized (n=16) and non-normalized (n=14) group, respectively (p<0.0001). Of the 25 pts achieving SD, CRP kinetics was independent prognostic factor for OS (p<0.0001). Of the pts whose pretreatment CRP was elevated, all pts achieving OR had CRP normalization and multivariate analysis revealed CRP normalization was independent prognostic factor for OS (p=0.0008), whereas achieving OR was not (p=0.19). Conclusions: CRP kinetics compares favorably with objective response to systemic therapy as a valid surrogate endpoint for survival. No significant financial relationships to disclose.

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