C-Reactive Protein May Improve Prediction of Partial Nephrectomy Outcomes

Preoperative C-reactive protein (CRP) levels improve prediction of partial nephrectomy outcomes, investigators revealed at the Society of Urologic Oncology 24th Annual Meeting in Washington, DC.

In a study of 456 patients undergoing partial nephrectomy, 316 (67.9%) achieved the trifecta of negative surgical margins, no major postoperative complications of Clavien Dindo grade 3 or higher, and a perioperative decline in estimated glomerular filtration rate (eGFR) of less than 30%.

As expected, the risk for all-cause mortality was a significant 62% lower for patients who achieved the trifecta compared with those who did not. Elevated preoperative CRP, however, was significantly associated with increased risk for all-cause mortality, Kit L. Yuen, MD, of the University of California, San Diego, reported on behalf of her team.

Dr Yuen and her colleagues established a high preoperative CRP level as 5 mg/L or more. In the non-trifecta group, a significantly lower proportion of patients with high vs low preoperative CRP survived for 5 years: 59.7% vs 91.3%. In the trifecta group, however, the 5-year overall survival rate did not differ significantly among patients with high vs low preoperative CRP: 90.1% vs 95.6%.

“Our findings suggest that non-trifecta patients with low preoperative CRP demonstrated similar outcomes to patients who achieved trifecta,” Dr Yuen’s team reported.

Preoperative CRP also distinguished patients who would experience clinically significant eGFR decline after surgery. In the non-trifecta group, freedom from stage 3b chronic kidney disease (an eGFR decline to less than 45 mL/min/1.73m²) occurred in a significantly lower proportion of patients with high vs low preoperative CRP: 63.2% vs 91.5%. In the trifecta group, freedom from stage 3b chronic kidney disease did not differ among patients: 83.9% vs 80.9% in the low vs high CRP group, respectively.

Incorporating CRP into the trifecta has implications for patient survival and functional outcomes following partial nephrectomy, according to the investigators. Dr Yuen and colleagues proposed a revised risk stratification system:

• Low risk: trifecta plus low CRP
• Intermediate risk: trifecta plus high CRP or no-trifecta plus low CRP
• High risk: no-trifecta plus high CRP

Compared with the trifecta alone, the proposed classification system scored lower on the Aikaike Information Criterion, indicating superior performance in predicting all-cause mortality and decline to stage 3b CKD after surgery, the investigators reported.

Reference

Yuen KL, Saitta C, Afari JA, et al. Incorporating C-reactive protein into the trifecta: implications for survival and functional outcomes following partial nephrectomy. Presented at the Society of Urologic Oncology’s 24th annual meeting, November 28-December 1, 2023. Poster 160.

This article originally appeared on Renal and Urology News