Prognostic impact of baseline serum C‐reactive protein in patients with metastatic renal cell carcinoma (RCC) treated with sunitinib. (15th January 2014)

• Record Type: Journal Article
• Authors: Beuselinck, Benoit; Vano, Yann‐Alexandre; Oudard, Stéphane; Wolter, Pascal; De Smet, Robert; Depoorter, Lore; Teghom, Corine; Karadimou, Alexandra; Zucman‐Rossi, Jessica; Debruyne, Philip R.; Van Poppel, Hendrik; Joniau, Steven; Lerut, Evelyne; Strijbos, Michiel; Dumez, Herlinde; Paridaens, Robert; Van Calster, Ben; Schöffski, Patrick
• Is Part Of: BJU international. Volume 114:Number 1(2014:Jul.)
• Page Start: 81
• Page End: 89
• Publication Date: 2014-01-15
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12494
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12494-sec-0001" sec-type="section"> <title>Objective</title> <p> <list id="bju12494-list-0001" list-type="bullet"> <list-item> <p>To evaluate the impact of baseline serum C‐reactive protein (CRP) level on outcome in patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib.</p> </list-item> </list> </p> </sec> <sec id="bju12494-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12494-list-0002" list-type="bullet"> <list-item> <p>We reviewed the charts of patients with mRCC who started sunitinib as a first targeted treatment between 2005 and 2012 in three hospitals in Belgium and France.</p> </list-item> <list-item> <p>Collected data included known prognostic factors for mRCC, anatomical location of metastatic sites, response rate (RR), progression‐free survival (PFS) and overall survival (OS).</p> </list-item> </list> </p> </sec> <sec id="bju12494-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12494-list-0003" list-type="bullet"> <list-item> <p>A total of 200 eligible patients were identified by retrospective chart review. The median PFS and OS were 12 and 20 months, respectively.</p> </list-item> <list-item> <p>We observed a clear impact of baseline CRP levels on outcome: the median PFS was 25 months in the group with baseline CRP ≤5 mg/L and 8 months in the group with baseline CRP >5 mg/L (hazard ratio [HR] 2.48, 95% CI 1.74–3.59). The median OS in each group was 50 vs 12 months, respectively (HR 3.17, 2.20–4.68). In the group with baseline CRP ≤5 mg/L, 61% of patients experienced a partial response compared with 32% of patients in the group with baseline CRP >5 mg/L (difference = 29%, 95% CI 15–42).</p> </list-item> <list-item> <p>When adding baseline CRP (with a log transformation) to the six variables of the International Metastatic RCC Database Consortium (IMDC) model in a multivariable Cox regression model, baseline CRP was independently associated with poor PFS (HR for each doubling in CRP level: 1.14, 95% CI 1.03–1.26; <italic>P</italic> = 0.01) and OS (HR: 1.29, 95% CI 1.16–1.43; <italic>P</italic> < 0.001).</p> </list-item> <list-item> <p>Adding baseline CRP to the model increased the c‐statistic of PFS at 5 years from 0.63 (0.59–0.68) to 0.69 (0.65–0.73), and the c‐statistic of OS at 5 years from 0.65 (0.60–0.69) to 0.70 (0.66–0.74).</p> </list-item> <list-item> <p>Patients with elevated baseline CRP levels had a poor prognosis independent of the IMDC risk group, whereas patients with a low baseline CRP in the IMDC favourable risk group had a very good outcome.</p> </list-item> </list> </p> </sec> <sec id="bju12494-sec-0004" sec-type="section"> <title>Conclusion</title> <p> <list id="bju12494-list-0004" list-type="bullet"> <list-item> <p>Baseline serum CRP level is a strong independent variable linked with RR, PFS and OS in patients with mRCC treated with sunitinib.</p> </list-item> </list> </p> </sec> </abstract>