Presentation Authors: Sakae Konishi*, Shingo Hatakeyama, Hirosaki, Japan, Toshiaki Tanaka, Sapporo, Japan, Yoshinori Ikehata, Toyama, Japan, Toshikazu Tanaka, Naoki Fujita, Yusuke Ishibashi, Hayato Yamamoto, Takahiro Yoneyama, Yasuhiro Hashimoto, Hirosaki, Japan, Kazuaki Yoshikawa, Mutsu, Japan, Toshiaki Kawaguchi, Aomori, Japan, Naoya Masumori, Sapporo, Japan, Hiroshi Kitamura, Toyama, Japan, Chikara Ohyama, Hirosaki, Japan
Introduction: To evaluate the impact of pretreatment C-reactive protein/albumin ratio (CAR) on prognosis and the effect of adding CAR in the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model for prognosis discrimination in patients with metastatic renal cell carcinoma (mRCC).
Methods: A retrospective study was performed in 176 patients with mRCC whoreceived first-line tyrosine kinase inhibitors. Prognostic value of CAR was tested using the Kaplanâ€“Meier method and Cox proportional regression models. The effect of adding CAR in the IMDC model (IMDC-CAR) for overall survival (OS) discrimination was evaluated using receiver operator characteristic (ROC) curves, integrated discrimination improvement (IDI), and net reclassification improvement (NRI).
Results: CAR was significantly different among the IMDC favorable-, intermediate-, and poor-risk groups. The optimal cutoff value of CAR for OS was defined as 0.05 by ROC analysis, and patients were stratified into two groups: CAR-low ( < 0.05) and CAR-high (â‰¥0.05). The CAR-high group was significantly associated with poor OS compared to the CAR-low group. The multivariate analysis confirmed that CAR and the IMDC model were independently associated with OS. The area under the curve (AUC) was significantly different between the IMDC (0.689) and IMDC-CAR (0.720) models for the NRI 0.458 (P = 0.002) and IDI 0.05 (P = 0.007).
Conclusions: CAR is a simple and independent predictor of OS in patients with mRCC. Predictive activity was significantly improved in the IMDC-CAR model compared to the IMDC model.