Login to Access Video or Poster Abstract: MP16-03
Sources of Funding: None

Introduction

Nephrectomy and inferior vena cava (IVC) thrombectomy for renal cell carcinoma (RCC) with IVC involvement is associated with significant morbidity and mortality, making accurate prognosis valuable. Systemic inflammatory markers have shown to be prognostic in malignancy. We assess preoperative C-reactive protein (CRP), albumin, and the modified Glasgow Prognostic Score (mGPS), which combines both assays, for prognostic utility in RCC with IVC thrombus.

Methods

From 2006-2016, one surgeon performed 149 cases of radical nephrectomy and IVC tumor thrombectomy. Only those with clear cell RCC and available laboratory data were included. Patients were assigned an mGPS score 0-2 based on preoperative lab values (0=CRP ≤ 10 mg/L, 1=CRP > 10 mg/L, and 2=CRP > 10 mg/L and albumin < 3.5 g/dL). Other factors included in the analysis were age, gender, race, body mass index, 2009 AJCC pathologic T and M stages, necrosis, and nuclear grade. Also examined were well-established prognostic scoring systems, the University of California Los Angeles Integrated Staging System and the Mayo Clinic Stage, Size, Grade, and Necrosis scoring system. Log-rank and multivariable regression analysis examined overall survival (OS).

Results

Of 117 clear cell RCC patients with IVC thrombus, the mortality rate was 38.4% over a median follow-up period of 12.6 months (interquartile range 4.8-32.4 months). Patients with albumin < 3.5 g/dL represented 62.7% of the population and those with CRP > 10 mg/L represented 67.7%. Those with mGPS scores 0, 1, and 2 represented 32.3%, 14.4%, and 53.54%, respectively. CRP > 10 mg/L (HR 4.94, 95% 1.7-14.2, p<0.001), albumin < 3.5 g/dL (HR 2.16, 95% 1.1-4.3, p=0.024), and mGPS=2 (HR 5.56, 95% 1.9-16.1, p=0.002) correlated with OS. After adjusting for other factors, only mGPS=2 (HR 4.25, 95% 1.4-13.3; p=0.01) was an independent predictor of OS. A secondary analysis of only non-metastatic patients maintained significance.

Conclusions

For patients with RCC and IVC involvement, elevated CRP and low albumin correlate with OS. Combining albumin with CRP in the modified Glasgow Prognostic Score independently predicts OS. The mGPS could serve as a useful clinical adjunct with regard to follow-up counseling and clinical trial design.

Funding

None