C-Reactive Protein

A Japanese study showed that serum levels of C-reactive protein (CRP)—a systemic marker of inflammation—prior to targeted therapy for mRCC can predict progression-free survival.4


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The study, conducted by Jun Teishima, MD, PhD, of Hiroshima University in Hiroshima, Japan, and colleagues, included 190 patients with mRCC who had serum CRP levels measured prior to treatment with molecular targeted agents.

Patients with pretreatment CRP levels of 0.5 mg/dL or higher were considered the “higher CRP group.” Patients with lower levels were considered the “lower CRP group.”

Of the 190 patients, 97 (51.1%) and 93 (48.9%) were categorized in the lower and higher CRP groups, respectively. The 1-year, 2-year, and 3-year PFS rates for the lower CRP group (53.9%, 39.1%, and 23.9%, respectively) were significantly higher than those for the higher CRP group (23.4%, 13.6%, and 0%, respectively).4

The investigators further classified the higher CRP group into two subgroups: those whose serum CRP level decreased after targeted therapy and those whose level did not decrease after therapy.

The 1-year and 2-year PFS rates for the decreased CRP subgroup (38.3% and 21.2%, respectively) were significantly greater than those for the non-decreased CRP subgroup (9.6% and 0%, respectively).4

The investigators concluded that a decrease in CRP level and knowledge of pretreatment CRP level are novel predictive factors for antitumor effects in patients with mRCC who receive targeted therapy.4

Previous research has identified CRP as a potential prognostic marker in patients with RCC. For example, in a study of 1,161 patients with RCC who had CRP measurements obtained prior to nephrectomy, Sandra Steffens, MD, of Hannover Medical School in Hannover, Germany, and colleagues found that patients with CRP levels of 4 mg/L to 10 mg/L and greater than 10 mg/L had a 1.67-fold and 2.48-fold increased risk of RCC-related death, respectively, than those with a CRP level below 4 mg/L.5

The 5-year cancer-specific survival rates for patients with CRP levels less than 4 mg/L, 4 mg/L to 10 mg/L, and greater than 10 mg/L were 89.4%, 77.9%, and 49.5%, respectively.

Nutritional Screening

In a prospective Chinese study that enrolled 300 patients with advanced RCC, Gu Weijie, MD, and colleagues at Fudan University in Shanghai, China, found that nutritional screening is strongly associated with overall survival.6

Of the 300 patients enrolled in the study, 31.7% and 21.3% were classified as at risk for malnutrition based on the Geriatric Nutritional Risk Index (GNRI) and Mini Nutritional Assessment-Short Form (MNA-SF) screening tools.

Using the GNRI, patients at low and high risk of malnutrition had a significant 1.5-fold and 3.1-fold increased risk of death compared with patients at normal risk. Using the MNA-SF, patients at high risk of malnutrition had a significant 2.7-times increased risk of death compared with normal-risk patients, whereas patients at low risk of malnutrition had a non-significant 1.3-fold increased risk of death.6

The study is not the first to find an association between nutritional deficiency and poor outcomes in patients with RCC following surgery.

A retrospective South Korean study led by Hyeon H. Kim, MD, of Seoul National University Hospital found that nutritional deficiency, as defined by body mass index (BMI), serum albumin, and cholesterol, was independently associated with a significant 39% increased risk for RCC recurrence and 2-fold increased risk of RCC-related death.7

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The study included 1,437 patients with RCC, of whom 932 and 505 underwent radical nephrectomies and partial nephrectomies, respectively.

Patients considered to be nutritionally deficient had two or three of the following nutritional risk factors: preoperative BMI less than 23 kg/m2, preoperative albumin level less than 3.5 g/dL, and preoperative cholesterol level less than 220 mg/dL, according to the investigators.

References

  1. Yagisawa T, Kondo T, Yoshida K, et al. The relationship between the timing of maximum tumor shrinkage during 1st-line targeted therapy and overall survival of patients with metastatic renal cell carcinoma. 2015 American Urological Association Annual Meeting. (Abstract MP69-17).
  2. Miyake H, Harada K-i, Fujisawa M. Early tumor shrinkage under first-line tyrosine kinase inhibitor as a surrogate endpoint of overall survival in patients with metastatic renal cell carcinoma. 2015 American Urological Association Annual Meeting. (Abstract PD35-02).
  3. Gruenwald V, Lin X, Kalanovic D, et al. Early tumor shrinkage (eTS) as a predictive and prognostic factor in metastatic renal cell carcinoma (mRCC). J Clin Oncol. 2015:33(suppl; abstr 4551).
  4. Teishima J, Kobatake K,  Kitano H, et al. The impact of change in serum C-reactive protein level on the prediction of effects of molecular targeted therapy in metastatic renal cell carcinoma patients.2015 American Urological Association Annual Meeting. (Abstract PD35-03).
  5. Steffens S, Köhler A, Rudolph R, et al. Validation of CRP as prognostic marker for renal cell carcinoma in a large series of patients. BMC Cancer. 2012;12:399.
  6. Weijie G, Ya Z, Dingwei Y. Nutritional screening is strongly associated with overall survival in patients treated with targeted agents for advanced renal cell carcinoma. 2015 American Urological Association Annual Meeting. (Abstract MP69-04).
  7. Ko K, Park YH, Lee JW, et al. Influence of nutritional deficiency on prognosis of renal cell carcinoma (RCC). BJU Int. 2013;112(6):775-780.