C-REACTIVE PROTEIN KINETICS ARE ASSOCIATED WITH PROGRESSION AND SURVIVAL IN SURGICALLY TREATED RENAL CELL CARCINOMA PATIENTS.

C-reactive protein (CRP) is an inflammatory marker whose elevation has been associated with worsened outcomes in renal cell carcinoma (RCC). Most studies have focused on pre-treatment values however, and there is a dearth of literature on impact of CRP dynamics. We sought to evaluate the impact of C-reactive protein dynamics (CRP) in Renal Cell Carcinoma (RCC) as biomarker for recurrence. We conducted a two center retrospective analysis of patients undergoing surgery for RCC.;;In all patients presenting for surgery, CRP was collected pre-operatively and postoperatively at 3 months, 6 months, then annually thereafter. The most recent CRP before recurrence was used to calculate delta CRP (postoperative– preoperative-CRP). Cut-point analysis employing concordance probability method was performed to determine the thresholds for preoperative CRP and delta CRP. Based on the ROC analysis, patients were stratified by preoperative CRP [low ≤1.5 mg/L (LCRP) vs. high >1.5mg/L (HCRP)], and by delta-CRP ≤1.5 mg/L (low-delta) vs. >1.5mg/L high-delta. Primary outcome was predictors of recurrence and secondary outcome was overall survival (OS). Multivariable analysis (MVA) via Cox regression was fitted for predictor of recurrence and all-cause mortality (ACM). Kaplan-Meier analysis (KMA) was assessed to compare this stratification for progression free (PFS) and overall survival (OS). 1932 patients were analyzed [LCRP/low-delta 773 (40.1%), LCRP/high-delta 292 (15.1%), HCRP/low-delta 689 (35.6%), HCRP/high-delta 178 (9.2%)]. MVA showed that LCRP/high-delta (HR 2.02, p<0.001), HCRP/low-delta (HR 1.7, p<0.001), and HCRP/high-delta (HR 2.28, p<0.001) were independent predictors associated with increased risk of recurrence. MVA for ACM demonstrated HCRP/low-delta (HR 2.64, p<0.001) and HCRP/high-delta (HR 4.89, p<0.001), associated with increased risk of mortality while LCRP/low-delta was not (p=0.32). 5 years PFS (Figure 1) was 91.1% for LCRP/low-delta, 86.5% for LCRP/high-delta, 80.7% for HCRP/low-delta and 73.% for HCRP/high-delta (p<0.001). 5-year OS (Figure 2) was 96.1% for LCRP/low-delta, 94.9% for LCRP/high-delta, 85.7% for HCRP/low-delta and 76.8% for HCRP/high-delta (p<0.001) Our findings suggest that CRP-kinetics is an independent predictor of worsened survival outcomes and recurrence, as such might may thus identify a subgroup of patients in which closer follow up or consideration for adjuvant therapy may be of benefit. Further investigation is requisite. [ABSTRACT FROM AUTHOR]