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Prognostic value of serum C-reactive protein level prior to second-line treatment in intermediate risk metastatic renal cell carcinoma patients

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Abstract

Background

The later-line treatment of metastatic renal cell carcinoma (mRCC) has been drastically changing by the development of immune-oncology drugs and molecular targeted treatment in recent years. Although the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model is useful for second-line setting, this model has the problem that over 50% patients are classified as intermediate risk group. The aim of this study is to evaluate whether the serum C-reactive protein (CRP) levels prior to second-line treatment could divide intermediate risk group patients.

Methods

We retrospectively reviewed 82 consequent intermediate-risk mRCC patients who received second-line molecular targeted therapy. We classified patients who had serum CRP higher than 0.5 mg/dl in elevated CRP group because the median baseline serum CRP level before second-line treatment was 0.51 mg/dl. We assessed the prognostic impact of serum CRP levels prior to second-line treatment initiation to predict overall survival (OS).

Results

Thirty-three out of 82 (40%) patients demonstrated elevated baseline CRP levels. The median OS of elevated and non-elevated CRP group was 11.5 (95% CI 5.4–17.5) and 29.4 (95% CI 25.5–33.5) months, respectively (p = 0.001). The serum CRP elevation could predict prognosis in intermediate risk patients treated with second-line treatment (HR 2.5, 95% CI 1.4–4.2, p = 0.001).

Conclusions

The serum CRP levels after first-line treatment termination could divide intermediate risk group mRCC patients into two prognostic subgroups in second-line targeted treatment setting.

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Acknowledgements

Supported in part by grants-in-aid from the Ministry of Education, Science, Sports, and Culture of Japan (17K11159 to R.M.).

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Authors and Affiliations

  1. Department of Urology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 1608582, Japan

    Kimiharu Takamatsu, Ryuichi Mizuno, Nobuyuki Tanaka, Toshikazu Takeda, Shinya Morita, Kazuhiro Matsumoto, Takeo Kosaka, Toshiaki Shinojima, Eiji Kikuchi, Hiroshi Asanuma & Mototsugu Oya

  2. Department of Uro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan

    Masafumi Oyama

  3. Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan

    Shuji Mikami

Authors
  1. Kimiharu Takamatsu
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  2. Ryuichi Mizuno
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  3. Nobuyuki Tanaka
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  4. Toshikazu Takeda
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  5. Shinya Morita
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  6. Kazuhiro Matsumoto
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  7. Takeo Kosaka
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  8. Toshiaki Shinojima
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  9. Eiji Kikuchi
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  10. Hiroshi Asanuma
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  11. Masafumi Oyama
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  12. Shuji Mikami
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  13. Mototsugu Oya
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Corresponding author

Correspondence to Ryuichi Mizuno.

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Conflict of interest

Ryuichi Mizuno MD has received honoraria from Bristol, Novartis, and Pfizer. Mototsugu Oya MD has received honoraria from Bayer, Bristol, Novartis, and Pfizer. Other authors declare that they have no conflict of interest.

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Takamatsu, K., Mizuno, R., Tanaka, N. et al. Prognostic value of serum C-reactive protein level prior to second-line treatment in intermediate risk metastatic renal cell carcinoma patients. Int J Clin Oncol 24, 1069–1074 (2019). https://doi.org/10.1007/s10147-019-01459-1

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  • DOI: https://doi.org/10.1007/s10147-019-01459-1

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