Predictive parameters of metastatic renal cell cancer

Czech version

Authors: Roman Sobotka; Otakar Čapoun; Viktor Soukup; Tomáš Hanuš
Authors‘ workplace: Urologická klinika 1. LF UK a VFN, Praha
Published in: Ces Urol 2014; 18(2): 101-111
Category: Original article

Overview

The goal of this study was to define clinical and laboratory parameters for metastatic renal cell carcinoma (RCC) in patients indicated for surgery.

A total of 218 patients underwent surgery for kidney tumors from May 2008 to February 2012. Age, sex, smoking history, body mass index, clinical symptoms, and selected laboratory and perioperative parameters were recorded for all patients. Histological examination included the type and tumor size, grade, and other histological findings. The significance of each parameter was evaluated using a nonparametric ANOVA (Wilcoxon test). The relative risk was assessed using a regression model to generalize the tumor. Multivariate analysis was performed using the Cox regression model.

The average age of the patients was 64 years old (22–84), 143 (66%) were males, and 62 (28%) were smokers. The mean BMI was 30.0 (19.1 to 45.2). Incidentally found RCC was described in 155 (71%) cases. Primary metastatic RCC was found in 36 (17%) patients. A total of 65 (30%) patients underwent kidney resection, 21 (32%) of which were performed laparoscopically. A benign tumor was diagnosed in 20 (9%) patients, with the most common cancer being clear cell RCC (72%). Statistically significant parameters for metastatic RCC were weight loss, CRP level, thrombocytosis, tumor size, and presence of symptoms (p < 0.0001), hemoglobin level (p = 0.0003), tumor grade (p = 0.0004), pT classification (p = 0.0006) and neutrophilia (p = 0.0239). Incidentally found tumour was a favorable parameter for localized tumor stage (p < 0.0001). Benign tumors were more frequently diagnosed in women (p = 0.0204). Blood loss, operating time, and duration of hospitalization were significantly different between open and laparoscopic procedures.

Many clinical and histological parameters showed a statistically significant difference, predicting a generalized RCC. The risk of metastatic RCC in patients with CRP > 15 ng/ml is 22 times higher, with hemoglobin < 120 g/l, 4.5 times higher with platelets above 350 × 10⁹ 9times, and with tumors above 9 cm in size it was 7–6 times higher.

Key words:
renal cell cancer, metastasis, tumor marker, prognostic factors, CRP.

Sources

1. SVOD: www.svod.cz

2. Leibovich BC, Blute ML, Cheville JC, Lohse CM, Frank I, Kwon ED, Weaver AL, Parker AS, Zincke H. Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. Cancer 2003; 97(7): 1663–1671.

3. Lau WK, Cheville JC, Blute ML, Weaver AL, Zincke H. Prognostic features of pathologic stage T1 renal cell carcinoma after radical nephrectomy. Urology 2002; 59(4): 532–537.

4. Cho DS, Kim SJ, Lee SH, Ahn HS, Kim YS, Kim SI. Prognostic significance of preoperative C-reactive protein elevation and thrombocytosis in patients with non-metastatic renal cell carcinoma. Korean J Urol 2011; 52(2): 104–109. doi: 10.4111/kju.2011.52.2.104. Epub 2011 Feb 21.

5. Citterio G, Bertuzzi A, Tresoldi M, Galli L, Di Lucca G, Scaglietti U, Rugarli C. Prognostic factors for survival in metastatic renal cell carcinoma: retrospective analysis from 109 consecutive patients. Eur Urol 1997; 31(3): 286–291.

6. van Rossum AP, Vlasveld LT, Vlasveld IN, Jansen PM, Dik WA, Hooijkaas H, Castel A. Granulocytosis and thrombocytosis in renal cell carcinoma: a pro-inflammatory cytokine response originating in the tumour. Neth J Med 2009; 67(5): 191–194.

7. Whiteside T. The role of immune cells in the tumor microenvironment the link between infl ammation and cancer. In Dalgleish AG, Haefner B eds, The Link Between Infl ammation and Cancer Wounds That Do Not Heal, Vol. 130. New York: Springer 2006; 103–124.

8. Suzuki A, Takahashi T, Nakamura K, Tsuyuoka R, Okuno Y, Enomoto T, Fukumoto M, Imura H. Thrombocytosis in patients with tumors producing colony-stimulating factor. Blood 1992; 80(8): 2052–2059.

9. Kruck S, Bedke J, Kuczyk MA, Merseburger AS. Second line systemic therapy for the treatment of metastaticrenal cell cancer. Expert Rev Anticancer Ther 2012; 12: 777–785.

10. Martella O, Galatioto GP, Necozione S, Pomante R, Vicentini C. Integrated staging systems for conventional renal cell carcinoma: a comparison of two prognostic models. Arch Ital Urol Androl 2011; 83(3): 121–127.

11. Zhang C, Li X, Hao H, Yu W, He Z, Zhou L. The correlation between size of renal cell carcinoma and its histopathological characteristics: a single center study of 1867 renal cell carcinoma cases. BJU Int 2012; 110(11): 481–485.

12. Ding GX, Song NH, Feng CC, Xia GW, Jiang HW, Hua LX, Ding Q. Is there an association between advanced stage of renal cell carcinoma and paraneoplastic syndrome? Med Princ Pract 2012; 21(4): 370–374.

13. Michigan A, Johnson TV, Master VA. Preoperative C-reactive protein level adjusted for comorbidities and lifestyle factors predicts overall mortality in localized renal cell carcinoma. Mol Diagn Ther 2011; 15(4): 229–234.

14. Bedke J, Chun FK, Merseburger A, Scharpf M, Kasprzyk K, Schilling D, Sievert KD, Stenzl A, Kruck S. Inflammatory prognostic markers in clear cell renal cell carcinoma – preoperative C-reactive protein does not improve predictive accuracy. BJU Int 2012; 110(11): 771–777.

15. Steffens S, Köhler A, Rudolph R, Eggers H, Seidel C, Janssen M, Wegener G, Schrader M, Kuczyk MA, Schrader AJ. Validation of CRP as prognostic marker for renal cell carcinoma in a large series of patients. BMC Cancer 2012; 12: 399.

16. García-Marchiñena P, Billordo-Perés N, Tobía-González I, Jurado A, Damia O, Gueglio G. High-sensitivity C-reactive protein as a predictor of locally advanced renal cell carcinoma. Arch Esp Urol 2012; 65(6): 601–607.

17. Johnson TV, Abbasi A, Owen-Smith A, Young AN, Kucuk O, Harris WB, Osunkoya AO, Ogan K, Pattaras J, Nieh PT, Marshall FF, Master VA. Postoperative better than preoperative C-reactive protein at predicting outcome after potentially curative nephrectomy for renal cell carcinoma. Urology 2010; 76(3): 766.e1–5.

18. Saito K, Tatokoro M, Fujii Y, Iimura Y, Koga F, Kawakami S, Kihara K. Impact of C-reactive protein kinetics on survival of patients with metastatic renal cell carcinoma. Eur Urol 2009; 55(5): 1145–1153.

19. Fischer K, Theil G, Hoda R, Fornara P. Serum amyloid A: a biomarker for renal cancer. Anticancer Res 2012; 32(5): 1801–1804.

20. Mittal A, Poudel B, Pandeya DR, Gupta SP, Sathian B, Yadav SK. Serum amyloid a as an independent prognostic factor for renal cell carcinoma – a hospital based study from the Western region of Nepal. Asian Pac J Cancer Prev 2012; 13(5): 2253–2255.

21. Brookman-May S, May M, Ficarra V, Kainz MC, Kampel-Kettner K, Kohlschreiber S, Wenzl V, Schneider M, Burger M, Wieland WF, Otto W,Tilki D, Gilfrich C, Hohenfellner M, Pahernik S, Chromecki TF, Stief C, Zigeuner R. Does preoperative platelet count and thrombocytosis play a prognostic role in patients undergoing nephrectomy for renal cell carcinoma? Results of a comprehensive retrospective series. World J Urol 2013; 31(5): 1309–1316.

22. Wosnitzer M, Polland A, Hai Q, Hruby G, McKiernan J. Role of preoperative platelet level in clinical and pathological outcomes after surgery for renal cortical malignancies. BJU Int 2011; 108(1): 73–79.

23. Seda CJ, Salas AS, Sánchez CG, Blasco JM, García IO, Sánchez JM, Ruíz CB, Navarro SM, López RA. Thrombocytosis and hematocrit as prognostic factors in renal carcinoma. Arch Esp Urol 2011; 64(9): 883–890.

24. Karakiewicz PI, Trinh QD, Lam JS, Tostain J, Pantuck AJ, Belldegrun AS, Patard JJ. Platelet count and preoperative haemoglobin do not significantly increase the performance of established predictors of renal cell carcinoma–specific mortality. Eur Urol 2007; 52(5): 1428–1436.

25. Ito K, Asano T, Yoshii H, Satoh A, Sumitomo M, Hayakawa M. Impact of thrombocytosis and C-reactive protein elevation on the prognosis for patients with renal cell carcinoma. Int J Urol 2006; 13(11): 1365–1370.

26. Choi Y, Park B, Kim K, Jeong BC, Seo SI, Jeon SS, Choi HY, Lee JE, Lee HM. Erythrocyte sedimentation rate and anaemia are independent predictors of survival in patients with clear cell renal cell carcinoma. Br J Cancer 2013; 108(2): 387–394.

27. Pichler M, Hutterer GC, Stoeckigt C, Chromecki TF, Stojakovic T, Golbeck S, Eberhard K, Gerger A, Mannweiler S, Pummer K, Zigeuner R. Validation of the pre-treatment neutrophil-lymphocyte ratio as a prognostic factor in a large European cohort of renal cell carcinoma patients. Br J Cancer 2013; 108(4): 901–907.

28. Ohno Y, Nakashima J, Ohori M, Gondo T, Hatano T, Tachibana M. Followup of neutrophil-to-lymphocyte ratio and recurrence of clear cell renal cell carcinoma. J Urol 2012; 187(2): 411–417.

29. Sejima T, Iwamoto H, Morizane S, Hinata N, Yao A, Isoyama T, Saito M, Takenaka A. The significant immunological characteristics of peripheral blood neutrophil-to-lymphocyte ratio and Fas ligand expression incidence in nephrectomized tumor in late recurrence from renal cell carcinoma. Urol Oncol 2013; 31(7): 1343–1349.

30. Ohno Y, Nakashima J, Ohori M, Hatano T, Tachibana M. Pretreatment neutrophil-to-lymphocyte ratio as an independent predictor of recurrence in patients with nonmetastatic renal cell carcinoma. J Urol 2010; 184(3): 873–878.

31. Du J, Zheng JH, Chen XS, Yang Q, Zhang YH, Zhou L, Yao X. High preoperative plasma fibrinogen is an independent predictor of distant metastasis and poor prognosis in renal cell carcinoma. Int J Clin Oncol 2013; 18(3): 517–523.

32. Sim SH, Messenger MP, Gregory WM, Wind TC, Vasudev NS, Cartledge J, Thompson D, Selby PJ, Banks RE. Prognostic utility of pre-operative circulating osteopontin, carbonic anhydrase IX and CRP in renal cell carcinoma. Br J Cancer 2012; 107(7): 1131–1137.

33. Ozer G, Altinel M, Kocak B, Yazicioglu A, Gonenc F. Value of urinary NMP-22 in patients with renal cell carcinoma. Urology 2002; 60(4): 593–597.

34. Morrissey JJ, London AN, Luo J, Kharasch ED. Urinary biomarkers for the early diagnosis of kidney cancer. Mayo Clin Proc 2010; 85(5): 413–421.

35. Papazisis KT, Kontovinis LF, Papandreou CN, Kouvatseas G, Lafaras C, Antonakis E, Christopoulou M, Andreadis C, Mouratidou D, Kortsaris AH. Brain natriuretic peptide precursor (NT-pro-BNP) levels predict for clinical benefit to sunitinib treatment in patients with metastatic renal cell carcinoma. BMC Cancer 2010; 10: 489.

36. Nisman B, Yutkin V, Nechushtan H, Gofrit ON, Peretz T, Gronowitz S, Pode D. Circulating tumor M2 pyruvate kinase and thymidine kinase 1 are potential predictors for disease recurrence in renal cell carcinoma after nephrectomy. Urology 2010; 76(2): 513.e1–6.

37. Macher-Goeppinger S, Aulmann S, Wagener N, Funke B, Tagscherer KE, Haferkamp A, Hohenfellner M, Kim S, Autschbach F, Schirmacher P, Roth W. Decoy receptor 3 is a prognostic factor in renal cell cancer. Neoplasia 2008; 10(10): 1049–1056.

38. Thompson RH, Zang X, Lohse CM, Leibovich BC, Slovin SF, Reuter VE, Cheville JC, Blute ML, Russo P, Kwon ED, Allison JP. Serum-soluble B7x is elevated in renal cell carcinoma patients and is associated with advanced stage. Cancer Res 2008; 68(15): 6054–6058.

39. Chang CH, Wu HC, Yen RF, Kao A, Lin CC, Lee CC. Tissue polypeptide specific antigen (TPS) as a tumor marker in renal cell carcinoma. Anticancer Res 2002; 22(5): 2949–2950.

40. Sobotka R, Čapoun O, Hanuš T. Leptin as a biomarker in renal cell carcinoma. Poster presentation on Central European Meeting, Prague 2013.

41. http: //nomograms.mskcc.org/Renal/PostSurgery.aspx.

42. http: //www.nomogram.org/Kidney/rcc_launch.php