Abstract 3583: Elevated inflammatory and hematological markers and survival in patients with renal cell carcinoma
Authors: Choi Yuni , Park Bumsoo , Jeong Byong Chang , Seo Seong Il , Jeon Seong Soo , Choi Han Yong , Lee Jung Eun , Lee Hyun Moo 
Published: August 2012

Abstract
Background: Growing evidence suggests the hypothesis that inflammatory and hematological markers may be related to cancer risk and survival; however, there is limited evidence for its relationship to renal cell carcinoma (RCC) survival. We therefore examined whether preoperative clinical biomarkers related to inflammatory and hematological responses, including erythrocyte sedimentation rate [ESR], alkaline phosphatase [ALP], white blood cell [WBC] count, hemoglobin [Hb] and hematocrit [Hct], predicted prognosis and survival in RCC patients. Methods: Data were collected retrospectively from 1,543 RCC patients treated with either radical- (n=1,259) or partial nephrectomy (n=284) in the Department of Urology at the Samsung Medical Center between 1994 and 2008. The primary endpoint evaluated was overall survival (OS), cancer-specific survival (CSS) and other-cause survival (OCS). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models with adjustment for other clinical risk factors for RCC mortality. Results: During a median follow-up of 44 months, a total of 208 (13%) patients died of all-cause, 174 (11%) died of cancer and the other 35 died of other-cause (2%). We found statistically significant associations of decreasing OS and CSS with increasing levels of ESR; HRs (95% CIs) were 1.64 (1.03-2.61; p-trend=0.009) for OS and 2.24 (1.29-3.88; p-trend=0.001) for CSS comparing top with bottom tertiles. Also, increase in ALP levels was associated with decreasing OS and CSS; comparing top with bottom tertiles, HR (95% CI) were 2.01 (1.30-3.11; p-trend=0.002) for OS and 2.27 (1.37-3.74; p-trend=0.002) for CSS. There was no association for OCS in relation to levels of ESR and ALP. For hematological markers, we found increasing OS, CSS, and OCS with increasing levels of Hb and Hct. Notably, inverse association was stronger for OCS than OS or CSS; HRs (95% CI)s for OCS were 0.24 (0.09-0.68; p-trend=0.006) for Hb and 0.14 (0.05-0.41; p-trend&lt;0.001) for Hct. In sensitivity analyses in which we excluded patients who died during the first 2 years of follow-up (n=98) or those who had metastasis (n=90), similar patterns of the associations were observed. When we limited the analysis to patients who did not have weight loss or symptom or those who had low stage, we still found improved OS or CSS with decreasing levels of ESR and ALP or increasing levels of Hb and Hct. Conclusions: These findings from a large clinical-based cohort suggest that increasing levels of inflammatory prognostic indicators, but decreasing levels of hematological markers are associated with worse survival among RCC patients treated with nephrectomy. Our findings support the hypothesis that ESR, ALP, Hb and Hct could be potential prognostic indicators for RCC survival.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3583. doi:1538-7445.AM2012-3583