Prognostic Significance of C-reactive Protein in Patients With Non-metastatic Papillary Renal Cell Carcinoma: Results from the INternational Marker Consortium for Renal Cancer (INMARC) Cohort

Published:March 09, 2022DOI:



      C-reactive protein is a useful biomarker for screening renal cell carcinoma (RCC); however, its significance in papillary RCC is unclear. We assessed the prognostic effect of serum C-reactive protein levels in patients with surgically treated non-metastatic papillary RCC.

      Patients and Methods

      We established an international multi-institutional database (the INternational Marker Consortium for Renal Cancer) of 3799 patients with surgically treated RCC. Among these, data of 400 patients with non-metastatic papillary RCC were analyzed. An elevated pretreatment serum C-reactive protein level was defined as > 10 mg/L. Associations of clinical covariates with recurrence-free survival were investigated.


      Among the patients, 174 were African Americans, 155 were European–Americans, 50 were Asians, and 21 were of other races. Pathological T stages were 1, 2, 3, and 4 in 313, 46, 32, and 3 patients, respectively. The median pretreatment C-reactive protein level was 1.0 mg/L; 48 patients exhibited an elevated C-reactive protein level. During follow-up (median 18 months), 30 patients presented recurrence. The 1-, 3-, and 5-year recurrence-free rates were 95%, 91%, and 87%, respectively. Multivariate analysis revealed a significant association of the elevated pretreatment C-reactive protein level with poor recurrence-free survival (hazard ratio 2.47, 95% confidence interval 1.03-5.48; P = .043). The 5-year recurrence-free survival was significantly worse for patients with elevated C-reactive protein levels (67% vs. 90%; P = .001).


      C-reactive protein is a significant prognostic factor for patients with non-metastatic papillary RCC and can serve as a useful adjunct biomarker for screening patients with a high risk of recurrence.



      ccRCC (clear cell renal cell carcinoma), CRP (C-reactive protein), cT stage (clinical T stage), cN stage (clinical N stage), HR (Hazard ratio), INMARC (INternational Marker Consortium for Renal Cancer), NLR (Neutrophil-to-lymphocyte ratio), pRCC (papillary renal cell carcinoma), pT stage (pathological T stage), pN stage (pathological N stage), RCC (Renal cell carcinoma), RFS (Recurrence-free survival)
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