PRE-OPERATIVE C-reactive protein (CRP) levels have been found to improve prediction of partial nephrectomy outcomes. Researchers from the University of California San Diego (USCD), USA, have shared their work.
In total, 456 patients undergoing partial nephrectomy were included, 316 (68%) of whom achieved the trifecta of negative surgical margins, no major post-operative complications of Clavien-Dindo Grade III or higher, and a peri-operative decline in estimated glomerular filtration rate (eGFR) of under 30%. Risk of all-cause mortality was a significant 62% lower in patients who achieved the trifecta, compared to those who did not. However, elevated pre-operative CRP was significantly associated with increased risk for all-cause mortality. A high pre-operative CRP level was defined as 5 mg/L or more.
In the non-trifecta group, a significantly lower proportion of patients with high compared to low pre-operative CRP survived for 5 years (59.7% compared to 91.3%). However, in the trifecta group, the 5-year overall survival rate did not differ significantly among patients with high versus low pre-operative CRP (90.1% versus 95.6%). Kit Yuen, USCD, reported: “Our findings suggest that non-trifecta patients with low pre-operative CRP demonstrated similar outcomes to patients who achieved trifecta.”
Pre-operative CRP distinguished patients who experienced 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 versus low pre-operative CRP (63.2% versus 91.5%). In the trifecta group, freedom from Stage 3B chronic kidney disease did not differ among patients in the low versus high CRP group 83.9% versus 80.9%, respectively.
The investigators proposed a revised risk stratification system based on their results. Compared with the trifecta alone, the proposed classification system scored lower on the Akaike Information Criterion, indicating superior performance in predicting all-cause mortality and decline to Stage 3B chronic kidney disease after surgery.
