Prognostic significance of the dynamic changes of systemic inflammatory response in metastatic renal cell carcinoma

ABSTRACT Purpose: To elucidate the prognostic value of systemic inflammatory response in patients with metastatic renal cell carcinoma (mRCC) who are treated with sunitinib, we evaluated the prognostic role of C-reactive protein (CRP) kinetics. This study also compared prognostic models containing CRP kinetics and neutrophil-to-lymphocyte ratio (NLR) kinetics. Materials and Methods: A consecutive cohort of 94 patients with mRCC who were treated with sunitinib was retrospectively included from Fudan University Shanghai Cancer Center. According to dynamic changes in CRP and the NLR, patients were divided into three groups for analysis of CRP and NLR kinetics. The associations between survival and potential prognostic factors were assessed. The incremental value of prognostication was evaluated. Results: A significant difference (P<0.001) in overall survival (OS) was observed among the three groups of CRP kinetics. The median OS of the non-elevated group was nearly 1.3-fold longer than that of the normalized group (33.0 vs. 26.3 months), and two times longer than that of the non-normalized group (33.0 vs. 14.0 months). Multivariate analysis showed that CRP and NLR kinetics were independent prognostic indicators. The model containing CRP kinetics had a better predictive accuracy than that with NLR kinetics, which was supported by the C-index (0.731 vs. 0.684) and the likelihood ratio χ2 test (79.9% vs. 44.9%). Conclusion: Our study suggests that dynamic changes in CRP can better predict survival in patients with mRCC who are treated with sunitinib. Routine assessment of CRP before and after targeted therapy would help identify patients at risk of a poor outcome.

PCA3 rs544190G>A and prostate cancer risk in an eastern Chinese population

ABSTRACT Background: The association of prostate cancer antigen 3 (PCA3) polymorphism (SNP, rs544190G>A) with metastatic prostate cancer in European descent has been reported. Our aim of the current study was to re-validate the effect of PCA3 polymorphism on prostate cancer risk in an Eastern Chinese population and then estimate possible genetic discrepancies among population. Materials and Methods: Taqman assay was employed to determine genotype of SNP rs544190 in 1015 ethnic Han Chinese patients with prostate cancer and 1032 cancer-free controls. Simultaneously, odds ratios (OR) and 95% confidence intervals (95%CI) for risk relationship were calculated by logistic regression models. Results: The statistically significant relationship between PCA3 rs544190G>A and higher prostate cancer risk was not found. Stratification analysis revealed that there was no remarkable association of rs544190 variant AG/AA genotype with prostate cancer risk in every subgroup, except for patients with Gleason score ≤7(3+4). Conclusion: Although the results demonstrated that SNP rs544190 was not involved in prostate cancer risk in Eastern Chinese descent, unlike in European population, these might have clinical implications on prostate cancer heterogeneity around the World. To validate these findings, well-designed studies with different ethnic populations are warranted.

Risk Factors of Perioperative Complications in Patients Undergoing Radical Retropubic Prostatectomy: A Ten-year Experience / 华中科技大学学报（医学）（英德文版）

Radical retropubic prostatectomy (RRP) has been one of the most effective treatments for prostate cancer.This study is designed to identify the related predictive risk factors for complications in patients following RRP.Between 2000 and 2012 in Department of Urology,Fudan University Shanghai Cancer Center,421 cases undergoing RRP for localized prostate cancer by one surgeon were included in this retrospective analysis.We reviewed various risk factors that were correlated with perioperative complications,including patient characteristics [age,body mass index (BMI),co-morbidities],clinical findings (preoperative PSA level,Gleason score,clinical stage,pathological grade),and surgeon's own clinical practice.Charlson comorbidity index (CCI) was used to explain comorbidities.The total rate of perioperative complications was 23.2％ (98/421).There were 45/421 (10.7％),28/421 (6.6％),24/421 (5.7％) and 1/421 (0.2％) in grade Ⅰ,Ⅱ,Ⅲ,Ⅳ respectively,and 323/421 (76.8％) cases had none of these complications.Statistical analysis of multiple potential risk factors revealed that BMI ＞30 (P=0.014),Charlson score ≥1 (P＜0.001) and surgical experience (P=0.0252) were predictors of perioperative complications.Age,PSA level,Gleason score,TNM stage,operation time,blood loss,and blood transfusion were not correlated with perioperative complications (P＞0.05).It was concluded that patients' own factors and surgeons' technical factors are related with an increased risk of development of perioperative complications following radical prostatectomy.Knowing these predictors can both favor risk stratification of patients undergoing RRP and help surgeons make treatment decisions.

Assessment of survival of patients with metastatic clear cell renal cell carcinoma after radical cytoreductive nephrectomy versus no surgery: a SEER analysis

Purposes To examine the factors related to the choice of cytoreductive nephrectomy (CN) for patients with metastatic clear cell renal cell carcinoma (mCCRCC), and compare the population-based survival rates of patients treated with or without surgery in the modern targeted therapy era. Materials and Methods From 2006 to 2009, patients with mCCRCC were identified from SEER database. The factors that affected patients to be submitted to CN were examined and propensity scores for each patient were calculated. Then patients were matched based upon propensity scores. Univariable and multivariable cox regression models were used to compare survival rates of patients treated with or without surgery. Finally, sensitivity analysis for the cox model on a hazard ratio scale was performed. Results Age, race, tumor size, T stage and N stage were associated with nephrectomy univariablely. After the match based upon propensity scores, the 1-, 2-, and 3-year cancer-specific survival rate estimates were 45.1%, 27.9%, and 21.7% for the no-surgery group vs 70.6%, 52.2%, and 41.7% for the surgery group, respectively (hazard ratio 0.42, 95%CI: 0.35-0.52, log-rank P<0.001). In multivariable Cox proportional hazard regression model, race, T stage, N stage and median household income were significantly associated with survival. Sensitivity analysis on a hazard ratio scale indicated that the hazard ratio might be above 1.00 only when the unknown factor had an opposite effect on survival which was 3-fold than CN. Conclusion The results of our study showed that CN significantly improves the survival of patients with metastatic CCRCC even in the targeted therapy era. .