Shifting the Paradigm: Improving Renal Cell Carcinoma Staging Within the AJCC System by Adding C-reactive Protein-Analysis of the INMARC Registry

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance I (MP36)1 May 2024MP36-07 SHIFTING THE PARADIGM: IMPROVING RENAL CELL CARCINOMA STAGING WITHIN THE AJCC SYSTEM BY ADDING C-REACTIVE PROTEIN-ANALYSIS OF THE INMARC REGISTRY Cesare Saitta, Jonathan A. Afari, Mimi V. Nguyen, Kevin Hakimi, Dattatraya Patil, Hajime Tanaka, Julian Cortes, Margaret F. Meagher, Mirha Mahmood, Joshua Matian, Mariam Mansour, Dhruv Puri, Clara Cerrato, Kit L. Yuen, Masaki Kobayashi, Shohei Fukuda, Nicolò M. Buffi, Giovanni Lughezzani, Yasuhisa Fujii, Viraj Master, Brian R. Lane, and Ithaar H. Derweesh Cesare SaittaCesare Saitta , Jonathan A. AfariJonathan A. Afari , Mimi V. NguyenMimi V. Nguyen , Kevin HakimiKevin Hakimi , Dattatraya PatilDattatraya Patil , Hajime TanakaHajime Tanaka , Julian CortesJulian Cortes , Margaret F. MeagherMargaret F. Meagher , Mirha MahmoodMirha Mahmood , Joshua MatianJoshua Matian , Mariam MansourMariam Mansour , Dhruv PuriDhruv Puri , Clara CerratoClara Cerrato , Kit L. YuenKit L. Yuen , Masaki KobayashiMasaki Kobayashi , Shohei FukudaShohei Fukuda , Nicolò M. BuffiNicolò M. Buffi , Giovanni LughezzaniGiovanni Lughezzani , Yasuhisa FujiiYasuhisa Fujii , Viraj MasterViraj Master , Brian R. LaneBrian R. Lane , and Ithaar H. DerweeshIthaar H. Derweesh View All Author Informationhttps://doi.org/10.1097/01.JU.0001008612.93052.9d.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although the American Joint Committee on Cancer (AJCC) classification for renal cell carcinoma (RCC) relies on cancer stage alone, AJCC staging for other cancers includes tumor grade and laboratory data. On the other hand, C-reactive protein (CRP) has been associated with worsened oncological outcomes in RCC. We hypothesized that integrating preoperative CRP within the AJCC stage classification system will allow for more accurate staging, outcome prediction, and clinical decision making. METHODS: We queried the INMARC registry for patients >18 affected by RCC. Multivariable analysis (MVA) via Cox regression was employed to test the efficacy of CRP to predict all-cause mortality (ACM). Receiver operating characteristic curve (ROC) analysis was performed to identify CRP thresholds that define low (LCRP) and high CRP (HCRP). We sorted the cohort based on the results of the ROC analysis (LCRP <5 mg/L; HCRP ≥5 mg/L) for survival assessment. Kaplan-Meier analyses (KMA) were fitted to elucidate survival estimates. Proposed classification was based on the KMA distributions for overall survival (OS). Model's performance was assessed with Akaike information criterion (AIC), and ROC analysis using estimated area under the curve (AUC) for ACM and cancer specific mortality (CSM). RESULTS: We identified 3,432 patients. MVA showed HCRP as an independent predictor of ACM (HR 2.50, p<0.001). Comparing stage I/LCRP vs. stage I/HCRP 5-year KMA for OS was 93.9% vs. 83.6% (p<0.001); for stage II/LCRP vs. stage II/HCRP, 5-year OS was 94.2% vs 76.6% (p<0.001). Comparing stage I/HCRP vs. stage III/low-CRP 5-year OS was 83.6% vs. 84.6% (p=0.8). Proposal classification is depicted in Figure 1. Proposed classification showed improved AUC relative to AJCC in predicting ACM and CSM (0.72 vs 0.67, p<0.001; 0.80 vs 0.78, p<0.001, respectively), and also exhibited lower AIC compared to AJCC (ACM: 9209.6 vs. 9398.3; CSM: 4514.6 vs. 4628.9) which is indicative of a superior model. CONCLUSIONS: We present a pragmatic classification that exhibits increased prognostic performance compared to the current AJCC staging system. Our results suggest reconsideration of the current paradigm for RCC staging to include both anatomopathological and biological data. Further investigation is requisite. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e594 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Cesare Saitta More articles by this author Jonathan A. Afari More articles by this author Mimi V. Nguyen More articles by this author Kevin Hakimi More articles by this author Dattatraya Patil More articles by this author Hajime Tanaka More articles by this author Julian Cortes More articles by this author Margaret F. Meagher More articles by this author Mirha Mahmood More articles by this author Joshua Matian More articles by this author Mariam Mansour More articles by this author Dhruv Puri More articles by this author Clara Cerrato More articles by this author Kit L. Yuen More articles by this author Masaki Kobayashi More articles by this author Shohei Fukuda More articles by this author Nicolò M. Buffi More articles by this author Giovanni Lughezzani More articles by this author Yasuhisa Fujii More articles by this author Viraj Master More articles by this author Brian R. Lane More articles by this author Ithaar H. Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...