Combined Charlson Comorbidity/C-Reactive Protein Index Is a Novel Predictor in Renal Cell Carcinoma: Analysis of the INternational MArker Consortium for Renal Cancer (INMARC) Registry

Objective To evaluate predictive ability of a novel combined index, Charlson Comorbidity Index and C-Reactive Protein (CCI-CRP), for outcomes in Renal Cell Carcinoma (RCC), and compare predictive outcomes with of CCI-CRP to its separate components and to the UCLA Integrated Staging System (UISS). Patients and Methods We retrospectively analyzed INMARC registry of RCC patients. Receiver Operator Characteristics (ROC) analysis was fitted to identify threshold defining low-CRP (LCRP) and high-CRP (HCRP). Patients were stratified according to CCI [low-CCI ≤3 (LCCI); intermediate-CCI 4-6 (ICCI); high-CCI >6 (HCCI)] and CRP level. Kaplan-Meier analysis (KMA) was conducted for overall (OS) and cancer-specific survival (CSS). Based on survival analysis distribution we proposed a new stratification: CCI-CRP. Model performance was assessed with ROC/area under the curve (AUC) analysis and compared to CCI and CRP alone, and UISS. Results We analyzed 2,890 patients (median follow-up 30 months). ROC identified maximum product sensitivity and specificity for CRP at 3.5 mg/L. KMA revealed 5-year OS of 95.6% for LCRP/LCCI, 83% LCRP/ICCI, 73.3% LCRP/HCCI, 62.6% HCRP/LCCI, 51.6% HCRP/ICCI and 40.5% HCRP/HCCI (p<0.001). From this distribution, new CCI-CRP is proposed: low CCI-CRP (LCRP/LCCI and LCRP/ICCI), intermediate CCI-CRP (LCRP/HCCI and HCRP/LCCI), and high CCI-CRP (HCRP/ICCI and HCRP/HCCI). AUC for CCI-CRP showed improved performance for predicting OS/CSS vs. CCI alone (0.73 vs. 0.63/0.77 vs. 0.60), CRP alone (0.73 vs. 0.71/0.77 vs. 0.74) and UISS (0.73 vs 0.67/0.77 vs 0.73). Conclusions CCI-CRP, exhibits increased prognostic performance for survival outcomes in RCC compared to CCI and CRP alone, and UISS. Further investigation is requisite. MicroAbstract We sought to evaluate a new prognostic clinical tool, combined Charlson-Comorbidity/C-Reactive protein Index, for use for patients with renal cell carcinoma. Retrospective analysis of 2890 patients from the INternational MArker Consortium for Renal Cancer registry reveals CCI-CRP exhibited increased prognostic performance for overall and cancer-specific survival in RCC compared to CCI and CRP alone, and the UCLA Integrated Staging System.