Impact Of Pretreatment C-Reactive Protein On Overall Survival For Patients With Metastatic Renal Cell Carcinoma Treated With Sunitinib.

436 Background: C-reactive protein (CRP) has been shown to be a significant prognostic factor for metastatic renal cell carcinoma (mRCC) in cytokine era. We further evaluated the prognostic impact of CRP for mRCC treated with sunitinib.Consecutive 37 patients were treated with sunitinib for mRCC from April 2008 to January 2011 at our institution. Seven patients were excluded because they received prior other tyrosine kinase inhibitors, sorafenib. Among eligible 30 patients, 9 patients (30%) had prior immunotherapy and 16 patients (55.5%) had prior nephrectomy. All clinical charts of the patients were reviewed for variables. Overall survival were estimated using the Kaplan-Meier method. Variables including hemoglobin, albumin, calcium, lactate dehydrogenase (LDH), thrombocytosis, number of the metastatic sites, ECOG performance status (PS), prior immunotherapy, prior nephrectomy, and pretreatment CRP concentration were evaluated. The cut-off point of pretreatment CRP concentration was set at 8mg/l. Multivariate analysis was carried out by Cox proportional hazard model. For all analysis the difference was considered significant when p < 0.05.Median follow up period was 9 months (range; 1 to 25 months). The 1-year overall and progression free survival rates for the entire cohort were 68.9% and 45.8%. During follow up, 6 patients (20 %) died of disease. In univariate analysis, pretreatment CRP was a significant factor for overall survival as well as thrombocytosis. Multivariate analysis showed pretreatment CRP was solely an independent prognostic factor for overall survival. The elevations of pretreatment CRP concentrations were found in 14 patients (46.7%). The median overall survival length of patients with nonelevated CRP concentrationswas not reached compared with that of patients with elevated CRP concentration of 9.9 months. The 1-year overall survival rates of the patients with preoperative CRP elevation (35.7%) were significantly worse than those of patients without CRP elevation (91.7%) (p = 0.012).CRP had also prognostic impact on overall survival for patients with mRCC treated with sunitinib.