To evaluate predictive ability of a novel combined index, Charlson comorbidity index and C-reactive protein (CCI-CRP), for outcomes in renal cell carcinoma (RCC), and compare predictive outcomes with of CCI-CRP to its separate components and to the UCLA integrated staging system (UISS).
We retrospectively analyzed INMARC registry of RCC patients. Receiver Operator Characteristics (ROC) analysis was fitted to identify threshold defining low-CRP (LCRP) and high-CRP (HCRP). Patients were stratified according to CCI [low-CCI ≤ 3 (LCCI); intermediate-CCI 4-6 (ICCI); high-CCI > 6 (HCCI)] and CRP level. Kaplan-Meier analysis (KMA) was conducted for overall (OS) and cancer-specific survival (CSS). Based on survival analysis distribution we proposed a new stratification: CCI-CRP. Model performance was assessed with ROC/area under the curve (AUC) analysis and compared to CCI and CRP alone, and UISS.
We analyzed 2,890 patients (median follow-up 30 months). ROC identified maximum product sensitivity and specificity for CRP at 3.5 mg/L. KMA revealed 5-year OS of 95.6% for LCRP/LCCI, 83% LCRP/ICCI, 73.3% LCRP/HCCI, 62.6% HCRP/LCCI, 51.6% HCRP/ICCI and 40.5% HCRP/HCCI (P < .001). From this distribution, new CCI-CRP is proposed: low CCI-CRP (LCRP/LCCI and LCRP/ICCI), intermediate CCI-CRP (LCRP/HCCI and HCRP/LCCI), and high CCI-CRP (HCRP/ICCI and HCRP/HCCI). AUC for CCI-CRP showed improved performance for predicting OS/CSS vs. CCI alone (0.73 vs. 0.63/0.77 vs. 0.60), CRP alone (0.73 vs. 0.71/0.77 vs. 0.74) and UISS (0.73 vs 0.67/0.77 vs 0.73).
CCI-CRP, exhibits increased prognostic performance for survival outcomes in RCC compared to CCI and CRP alone, and UISS. Further investigation is requisite.
Clinical genitourinary cancer. 2024 May 27 [Epub ahead of print]
Julian A Cortes, Cesare Saitta, Kit L Yuen, Dattatraya Patil, Hajime Tanaka, Dhruv Puri, Jonathan A Afari, Mirha Mahmood, Joshua Matian, Mariam Mansour, Aaron Ahdoot, Luke Wang, Margaret F Meagher, Melis Guer, Mai Dabbas, Mimi V Nguyen, Clara Cerrato, Masaki Kobayashi, Shohei Fukuda, Yasuhisa Fujii, Viraj Master, Ithaar H Derweesh
Department of Urology, UC San Diego School of Medicine, La Jolla, USA., Department of Urology, Emory University School of Medicine, Atlanta, USA., Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan., Department of Urology, UC San Diego School of Medicine, La Jolla, USA. Electronic address: .