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26 November 2019 : Clinical Research  

C-Reactive Protein Levels and Survival Following Cytoreductive Nephrectomy in 118 Patients with Metastatic Renal Cell Carcinoma Treated with Sunitinib: A Retrospective Study

Wen-Hao Xu12BCDEF, Jun Wang12BCDE, Da-Zhu Huo3BCDE, Guo-Cai Yin4BCDF, Da-Long Cao12ABC, Guo-Hai Shi12BCDF, Yuan-Yuan Qu12ABG*, Ding-Wei Ye12ADG, Hai-Liang Zhang12ADFG

DOI: 10.12659/MSM.918635

Med Sci Monit 2019; 25:8984-8994

Abstract

BACKGROUND: This study aimed to evaluate the factors associated with a survival benefit for patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib, with and without cytoreductive nephrectomy (CN).

MATERIAL AND METHODS: This retrospective clinical study included 118 patients with mRCC who were treated with CN and sunitinib (CN-sunitinib) (N=70) and with sunitinib-alone (N=48). Categorical clinicopathological variables were compared with hypothesis tests using contingency tables and a chi-squared test. Independent indicators for progression-free survival (PFS) and overall survival (OS) were analyzed with univariate and multivariate Cox regression models. The Kaplan-Meier method and log-rank test were used to evaluate patient survival.

RESULTS: The median PFS and OS for the 118 patients were 8.38 and 15.48 months, respectively. There were no significant differences between the CN-sunitinib group and the sunitinib-alone group for either PFS (7.2 months vs. 11.6 months; P=0.525) or OS (16.7 months vs. 15.2 months; P=0.839). Stratification of patients based on clinicopathological characteristics showed that CN was significantly associated with reduced PFS and OS for patients with lymph node metastasis (PFS, P<0.001; OS, P<0.001) and high International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk scores (PFS, P=0.003; OS, P=0.011). However, CN was associated with a significant survival benefit for patients with low levels of serum C-reactive protein (CRP<10 mg/L) (PFS, P=0.026; OS, P=0.007).

CONCLUSIONS: Sunitinib-alone without CN improved the survival of patients with mRCC who had high IMDC risk scores or lymph node metastasis. CN and sunitinib resulted in significantly improved survival in patients with low serum CRP.

Keywords: C-Reactive Protein, Carcinoma, Renal Cell, Nephrectomy, Prognosis, Aged, Antineoplastic Agents, China, Cytoreduction Surgical Procedures, Disease-Free Survival, Indoles, Kaplan-Meier Estimate, Kidney Neoplasms, Middle Aged, Progression-Free Survival, Proportional Hazards Models, Pyrroles, Retrospective Studies, Sunitinib, Treatment Outcome

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750