Prognostic Significance of Preoperative C-Reactive Protein in Localized Clear Cell Renal Cell Carcinoma

Purpose: The prognostic significance of C-reactive protein (CRP) in clear cell renal cell carcinoma remains incompletely understood. We investigated the association between CRP levels and oncological outcomes in patients undergoing nephrectomy for localized clear cell renal cell carcinoma. Materials and Methods: A retrospective analysis was conducted using data from a Japanese multicenter database, including 1237 patients with localized clear cell renal cell carcinoma (cT1-3N0M0) who underwent radical or partial nephrectomy. Survival outcomes were assessed using the Kaplan-Meier method and Cox proportional hazards models, with restricted cubic splines used to evaluate nonlinear relationships. Results: The median follow-up duration was 39 months. Higher preoperative CRP levels were associated with increased overall mortality and risk of recurrence. Spline regression analysis demonstrated a nonlinear association between the actual CRP level and the hazard ratio of overall mortality ( P for nonlinearity = .003). In contrast, a nonlinear association between the logarithmic CRP level and the hazard ratio of overall mortality was not observed. Multivariate analysis revealed that including CRP (cutoff, 3 mg/L) resulted in the greatest improvement in the concordance index. Similarly, elevated CRP levels were associated with a higher risk of recurrence. Actual CRP levels showed a nonlinear association with the hazard ratio for recurrence risk ( P for nonlinearity < .001). Conclusions: An elevated preoperative CRP level is a significant prognostic factor for overall survival and recurrence in localized clear cell renal cell carcinoma.