BACKGROUND - To assess the prognostic value of preoperative C-reactive protein (CRP) serum levels for prognostication of biochemical recurrence (BCR) after radical prostatectomy (RP) in a large multi-institutional cohort.
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METHODS - Data from 7205 patients treated with RP at five institutions for clinically localized prostate cancer (PCa) were retrospectively analyzed. Preoperative serum levels of CRP within 24 h before surgery were evaluated. A CRP level ⩾0. 5 mg dl(-1) was considered elevated. Associations of elevated CRP with BCR were evaluated using univariable and multivariable Cox proportional hazards regression models. Harrel's C-index was used to assess prognostic accuracy (PA).
RESULTS - Patients with higher Gleason score on biopsy and RP, extracapsular extension, seminal vesicle invasion, lymph node metastasis, and positive surgical margins status had a significantly elevated preoperative CRP compared to those without these features. Patients with elevated CRP had a lower 5-year BCR survival proportion as compared to those with normal CRP (55% vs 76%, respectively, P<0. 0001). In pre- and postoperative multivariable models that adjusted for standard clinical and pathologic features, elevated CRP was independently associated with BCR (P<0. 001). However, the addition of preoperative CRP did not improve the accuracy of the standard pre- and postoperative models for prediction of BCR (70. 9% vs 71% and 78. 9% vs 78. 7%, respectively).
CONCLUSIONS - Preoperative CRP is elevated in patients with pathological features of aggressive PCa and BCR after RP. While CRP has independent prognostic value, it does not add prognostically or clinically significant information to standard predictors of outcomes. Prostate Cancer and Prostatic Diseases advance online publication, 26 January 2016; doi:10. 1038/pcan. 2015. 60.
Prostate cancer and prostatic diseases. 2016 Jan 26 [Epub ahead of print]
S Sevcenco, R Mathieu, P Baltzer, T Klatte, H Fajkovic, C Seitz, P I Karakiewicz, M Rouprêt, M Rink, L Kluth, Q-D Trinh, W Loidl, A Briganti, D S Scherr, S F Shariat
Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria. , Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria. , Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria. , Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria. , Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria. , Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria. , Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada. , Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France. , Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. , Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. , School of Medicine, Sacramento, CA, USA. , Department of Urology, Krankenhaus der Barmherzigen Schwestern, Linz, Austria. , Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy. , Department of Urology, Weill Cornell Medical College, New York, NY, USA. , Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria.