- Email: [email protected]
COMPARISON OF RATES AND RISK FACTORS FOR DEVELOPMENT OF ANEMIA FOLLOWING RADICAL NEPHRECTOMY OR PARTIAL NEPHRECTOMY
352
THE JOURNAL OF UROLOGY®
986 EXTENT OF TUMOR NECROSIS IS AN INDEPENDENT PROGNOSTIC FACTOR FOR PAPILLARY RENAL CELL CARCINOMA Tobias Klatte*, Mesut Remzi, Vienna, Austria; Jonathan W Said, Los Angeles, CA; Andrea Haitel, Vienna, Austria; Fairooz Kabbinavar, Los Angeles, CA; Matthias Waldert, Michela de Martino, Michael Marberger, Vienna, Austria; Arie S Belldegrun, Allan J Pantuck, Los Angeles, CA INTRODUCTION AND OBJECTIVE: Tumor necrosis has been reported to be an independent prognostic factor for clear cell renal cell carcinoma, but its prognostic role in the papillary subtype (PRCC) is less well studied. We hypothesized that necrosis is an independent prognostic factor for PRCC and that sub-classification according to necrosis extent is prognostically relevant. To test these hypotheses, we studied a large series from two institutions. METHODS: From a cohort of 2687 patients treated for a renal tumor between 1989 and 2008 at 2 academic centers, 258 (10%) were found to have PRCC. H&E slides were reviewed by one uro-pathologist at each institution. Both the presence and pathological extent of tumor necrosis were evaluated according to a previously described 3-tiered system (no necrosis, necrosis a20%, necrosis >20%). Kaplan-Meier survival estimates and Cox proportional hazards regression models addressed the prognostic impact of variables on cancer-specific survival (CSS). Predictive accuracy was assessed by Concordance (C) indices. RESULTS: Tumor necrosis was present in 119 tumors (46%), of which 55 (21%) showed necrosis in less than 20% and 64 (25%) in more than 20% of the tumor. Both presence and extent of necrosis were significantly associated with advanced TNM stages, higher grades, type 2 tumors, presence of vascular invasion, and increased tumor sizes (each p<0.001). In terms of CSS, 5-years survival rates for tumors without vs. with necrosis were 86% vs. 62%, respectively (p<0.0001). Furthermore, presence of necrosis was retained as an independent prognostic factor in multivariate analysis (HR 2.26, 95% CI 1.14-4.44, p=0.018). However, predictive accuracy of the extent-based classification was higher than for presence alone (c-index 66.8% vs. 63.9%). Five -year CSS rates for tumors without, a20% and >20% necrosis were 86%, 73%, and 52%, respectively (p<0.0001). In multivariate analysis, extent of necrosis was retained as an independent prognostic factor (HR 1.75, 95% CI 1.212.54, p=0.003). CONCLUSIONS: Both presence and extent of tumor necrosis are adverse, independent prognostic factors for PRCC. Sub-classification of necrosis according to its extent is prognostically relevant. Since predictive accuracy of the extent-based classification is superior to presence only, scoring of tumor necrosis according to its extent with further subclassification based on a 20% cut-off is recommended as part of every pathological examination. Source of Funding: None
987 POSITIVE SURGICAL MARGINS IN PARTIAL NEPHRECTOMY DO NOT IMPACT INTERMEDIATE-TERM SURVIVAL: A POPULATION BASED STUDY Robert Abouassaly*, Shabbir M.H. Alibhai, Nasir Shah, Narhari Timilshina, Neil E. Fleshner, Antonio Finelli, Toronto, ON, Canada INTRODUCTION AND OBJECTIVE: The importance of positive surgical margins (PSM) in partial nephrectomy (PN) for the treatment of renal cell carcinoma (RCC) has long been debated. Recent evidence from single center series suggests that a PSM has no impact on prognosis. Our aim is to determine the prevalence of PSM on a population level, determine predictors of PSM, and to assess the impact of PSM on survival in RCC. METHODS: Using the Ontario Cancer Registry, we identified 788 patients treated with PN for RCC in the province of Ontario, Canada between 1995 and 2004. Pathology reports were available for review on a random subsample of 439 patients (56%). Demographic information
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
was obtained, as well as tumor stage, grade, size, and surgeon’s year of graduation. Multivariable logistic regression was performed to determine predictors of PSM, and Kaplan Meier methods were used to examine disease specific (DSS) and overall survival (OS) by surgical margin status. Finally, a multivariable Cox proportional hazards model was used to determine the independent association between PSM and OS. RESULTS: Mean patient age was 57.7 years and 61.6% were men. Tumor size was <2.0 cm in 25%, 2.0-3.9 cm in 63%, 4.0-6.9 cm in 10%, and q7.0 cm in 2%. A high nuclear grade was found in a minority of tumors (14.5% Fuhrman grade 3-4). 56 patients (13.8%) had PSM on final pathology. In a multivariable model, neither age, gender, stage, grade, nor surgeon’s year of graduation was significantly associated with PSM. At a median follow-up of 5.7 years, the unadjusted 5-year DS and OS were 98.4% and 94.3%, respectively. Survival did not differ by surgical margin status, with 96.2% and 92.1% 5-year DSS and OS for patients with PSM, compared to 98.7% and 94.5% for those with negative margins (p=NS by log-rank test). Using a Cox model surgical margin status was not associated with time to all-cause death (p=0.53). CONCLUSIONS: Our population-level data suggests that although PSM is fairly prevalent at 13.8%, it appears to have little to no impact on 5-year survival among patients undergoing PN for RCC. Longer follow-up is required to determine the impact of PSM in RCC. Source of Funding: None
988 COMPARISON OF RATES AND RISK FACTORS FOR DEVELOPMENT OF ANEMIA FOLLOWING RADICAL NEPHRECTOMY OR PARTIAL NEPHRECTOMY Aditya Bagrodia*, Memphis, TN; Christopher J. DiBlasio, Memphist, TN; John B. Malcolm, Reza Mehrazin, Memphis, TN; Jonathan Silberstein, Marianne Chenoweth, Tracy Downs, Christopher J Kane, Robert W. Wake, Anthony L. Patterson, Jim Y Wan, Ithaar H Derweesh, La Jolla, CA INTRODUCTION AND OBJECTIVE: Anemia is a significant cause of morbidity and mortality in chronic kidney disease. We examined the incidence and risk factors for developing anemia and requiring Erythropoiesis-stimulating agents (ESA) in patients who underwent radical nephrectomy (RN) and partial nephrectomy (NSS). METHODS: Retrospective review of 905 patients (mean age 57.5 years, mean follow-up 5.8 years) who underwent RN or NSS for renal tumors at two institutions from 7/1987 to 6/2007. Demographics, renal function and metabolic parameters [Glomerular Filtration Rate (GFR), serum bicarbonate] and history of preoperative and postoperative anemia [WHO definition: Hemoglobin (g/dL) < 13 in males and <12 in females] and ESA utilization were recorded. Data were analyzed within subgroups based on treatment (RN vs. NSS). Multivariate analysis (MVA) was conducted to elucidate risk factors for development of anemia following surgery. RESULTS: There were no significant differences with respect to mean follow-up, age, race, sex, or BMI. 610 patients underwent RN and 295 underwent NSS. Tumor size (cm) was significantly larger for RN (RN 7.0 vs. NSS 3.7, p<0.0001). No significant difference was noted with respect to preoperative anemia (RN 16.4% vs. NSS 18.6%. p=0.406) and ESA treatment (RN 0.7% vs. NSS 1.4%, p=0.292). Postoperatively, significantly less de novo anemia (NSS 4.1% vs. RN 17.5%, p=0.0006) and ESA utilization (NSS 2.7% vs. RN 13.4%, p=0.005) developed in the NSS cohort. MVA demonstrated Ageq60 (OR 1.62, p=0.008), African-American (OR 2.30, p<0.0001), smoking history (OR 1.60, p=0.13), preoperative GFR <60 mL/min/1.73m2, (OR=4.09, p<0.0001), preoperative q1+ proteinuria (OR 2.19, p=0.03), preoperative metabolic acidosis (OR=4.08, p=0.007), and RN (OR 2.58, p<0.0001) as significantly associated with de novo development of anemia. CONCLUSIONS: Patients who underwent RN had a significantly higher incidence of de novo anemia and ESA requirement in comparison to a contemporary, well-matched cohort that underwent NSS. In addition to RN, ageq60, African-American, history of smoking, GFR<60, proteinuria, and metabolic acidosis were associated with developing
THE JOURNAL OF UROLOGY®
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
353
anemia. Multivariate analysis for variables associated with development of anemia Variable Age q 60 (Yes vs. No) Race (African-American vs. Caucasian-Other) History of Smoking (Yes vs. No)
Odds Ratio 1.62
95% Confidence Interval 1.13-2.22
2.30
1.63-3.25
P value 0.008 <0.0001
1.60
1.10-2.32
0.013
Preoperative GFR < 60 (Yes vs. No)
4.09
2.11-7.94
<0.0001
Preoperative proteinuria (Yes vs. No) Preoperative Metabolic Acidosis (Yes vs. No) RN vs. NSS
2.19
1.08-4.46
0.03
4.08
1.48-11.25
0.007
2.58
1.78-3.82
<0.0001
Source of Funding: None
989 HISTOLOGICAL SUBTYPES OF LOCALIZED RENAL CELL CARCINOMA (RCC)CORRELATE WITH TUMOR SIZE: A SEER ANALYSIS Jason Rothman*, Brian L Egleston, Yu-Ning Wong, Kevan Iffrig, Steve Lebovitch, Robert G Uzzo, Philadelphia, PA INTRODUCTION AND OBJECTIVE: Histology is an important prognostic variable when counseling patients with localized RCC. We investigated the relationship between tumor size and histology in patients with localized RCC. METHODS: Data from Surveillance, Epidemiology and End Results (SEER) were used to create a cohort of patients with localized, node negative RCC (1988-2004). Multinomial logistic models were used to predict the probability of specific histologies based on increasing primary tumor size. RESULTS: 19,932 patients in SEER with localized RCC were evaluated. 88% (17,552) patients had clear cell RCC, 4.4% (865) had papillary RCC, 1.9% (388) had chromophobe RCC. A high probability of detecting clear cell RCC was found for all tumor sizes; although localized clear cell RCCs were less commonly very large (Figure 1). Papillary RCC exhibited a u-shaped relationship between histology and tumor size such that at 10 cm the probability of papillary RCC increased with increasing tumor size (Figure 2). The probability of chromophobe RCC also increased with tumor size (Figure 3). Multinomial models predict the probability of papillary vs clear cell RCC decreases with tumor size (OR=0.95 per 1 cm increase, p<0.001) while the odds of chromophobe vs clear cell RCC increases with tumor size (OR=1.08 per 1 cm increase in size, p<0.001). CONCLUSIONS: The probability of detecting particular histologies varies with increasing primary tumor size such that localized clear cell RCCs were less often very large. Additionally, the incidence of both papillary and chromophobe histologies increased with primary tumor size. These data provide insight into the basic biology of localized RCC and have implications when counseling patients with large localized renal masses.
Source of Funding: The Fox Chase Kidney Cancer Keystone Program
990 INVESTIGATION OF PREOPERATIVE SERUM C-REACTIVE PROTEIN LEVEL ON THE PROGNOSIS FOR PATIENTS WITH LOCALIZED RENAL CELL CARCINOMA Soichi Mugiya*, Seiichiro Ozono, Masao Nagata, Tatsuya Takayama, Yutaka Kurita, Hamamatsu, Japan INTRODUCTION AND OBJECTIVE: Serum level of C-reactive protein (CRP) is frequently increased in patients with cancer, and was found to be associated with the prognosis in patients with advanced renal cell carcinoma (RCC). However, there are few studies that have examined the prognostic value of CRP in patients with localized RCC. We attempted to evaluate the importance of the preoperative serum CRP level on the prognosis for patients with localized RCC. METHODS: We studied retrospectively the records of 617 patients with RCC who underwent curative resection under classification as T1-3aN0M0. Disease-free and overall survival rates were estimated using the Kaplan-Meier method, and its associations with the CRP and other clinical and pathologic features were evaluated using Cox proportional hazard model. We also examined the predictive value of CRP as a predictor for recurrence, using receiver-operator characteristic (ROC) analysis. RESULTS: T classification included T1a in 321 patients, T1b in 172, T2 in 64, and T3a in 60. Of the 617 patients, 65 patients presented recurrence of RCC during a median follow-up of 57 months (range: 1-251). Disease-free survival rates at 5 and 10 years accounted for 88 and 81%, respectively. Patients with elevated CRP levels had significantly higher pathological T stage and histological grade. The preoperative serum CRP levels in patients with recurrence (1.956±3.570) were significantly higher than those in patients with non-recurrence (0.937±3.158) (p<0.0001). Using ROC analysis, CRP threshold value of 0.25 mg/dL gave a high sensitivity and specificity for recurrence. Analysis of disease-free and
THE JOURNAL OF UROLOGY®
986 EXTENT OF TUMOR NECROSIS IS AN INDEPENDENT PROGNOSTIC FACTOR FOR PAPILLARY RENAL CELL CARCINOMA Tobias Klatte*, Mesut Remzi, Vienna, Austria; Jonathan W Said, Los Angeles, CA; Andrea Haitel, Vienna, Austria; Fairooz Kabbinavar, Los Angeles, CA; Matthias Waldert, Michela de Martino, Michael Marberger, Vienna, Austria; Arie S Belldegrun, Allan J Pantuck, Los Angeles, CA INTRODUCTION AND OBJECTIVE: Tumor necrosis has been reported to be an independent prognostic factor for clear cell renal cell carcinoma, but its prognostic role in the papillary subtype (PRCC) is less well studied. We hypothesized that necrosis is an independent prognostic factor for PRCC and that sub-classification according to necrosis extent is prognostically relevant. To test these hypotheses, we studied a large series from two institutions. METHODS: From a cohort of 2687 patients treated for a renal tumor between 1989 and 2008 at 2 academic centers, 258 (10%) were found to have PRCC. H&E slides were reviewed by one uro-pathologist at each institution. Both the presence and pathological extent of tumor necrosis were evaluated according to a previously described 3-tiered system (no necrosis, necrosis a20%, necrosis >20%). Kaplan-Meier survival estimates and Cox proportional hazards regression models addressed the prognostic impact of variables on cancer-specific survival (CSS). Predictive accuracy was assessed by Concordance (C) indices. RESULTS: Tumor necrosis was present in 119 tumors (46%), of which 55 (21%) showed necrosis in less than 20% and 64 (25%) in more than 20% of the tumor. Both presence and extent of necrosis were significantly associated with advanced TNM stages, higher grades, type 2 tumors, presence of vascular invasion, and increased tumor sizes (each p<0.001). In terms of CSS, 5-years survival rates for tumors without vs. with necrosis were 86% vs. 62%, respectively (p<0.0001). Furthermore, presence of necrosis was retained as an independent prognostic factor in multivariate analysis (HR 2.26, 95% CI 1.14-4.44, p=0.018). However, predictive accuracy of the extent-based classification was higher than for presence alone (c-index 66.8% vs. 63.9%). Five -year CSS rates for tumors without, a20% and >20% necrosis were 86%, 73%, and 52%, respectively (p<0.0001). In multivariate analysis, extent of necrosis was retained as an independent prognostic factor (HR 1.75, 95% CI 1.212.54, p=0.003). CONCLUSIONS: Both presence and extent of tumor necrosis are adverse, independent prognostic factors for PRCC. Sub-classification of necrosis according to its extent is prognostically relevant. Since predictive accuracy of the extent-based classification is superior to presence only, scoring of tumor necrosis according to its extent with further subclassification based on a 20% cut-off is recommended as part of every pathological examination. Source of Funding: None
987 POSITIVE SURGICAL MARGINS IN PARTIAL NEPHRECTOMY DO NOT IMPACT INTERMEDIATE-TERM SURVIVAL: A POPULATION BASED STUDY Robert Abouassaly*, Shabbir M.H. Alibhai, Nasir Shah, Narhari Timilshina, Neil E. Fleshner, Antonio Finelli, Toronto, ON, Canada INTRODUCTION AND OBJECTIVE: The importance of positive surgical margins (PSM) in partial nephrectomy (PN) for the treatment of renal cell carcinoma (RCC) has long been debated. Recent evidence from single center series suggests that a PSM has no impact on prognosis. Our aim is to determine the prevalence of PSM on a population level, determine predictors of PSM, and to assess the impact of PSM on survival in RCC. METHODS: Using the Ontario Cancer Registry, we identified 788 patients treated with PN for RCC in the province of Ontario, Canada between 1995 and 2004. Pathology reports were available for review on a random subsample of 439 patients (56%). Demographic information
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
was obtained, as well as tumor stage, grade, size, and surgeon’s year of graduation. Multivariable logistic regression was performed to determine predictors of PSM, and Kaplan Meier methods were used to examine disease specific (DSS) and overall survival (OS) by surgical margin status. Finally, a multivariable Cox proportional hazards model was used to determine the independent association between PSM and OS. RESULTS: Mean patient age was 57.7 years and 61.6% were men. Tumor size was <2.0 cm in 25%, 2.0-3.9 cm in 63%, 4.0-6.9 cm in 10%, and q7.0 cm in 2%. A high nuclear grade was found in a minority of tumors (14.5% Fuhrman grade 3-4). 56 patients (13.8%) had PSM on final pathology. In a multivariable model, neither age, gender, stage, grade, nor surgeon’s year of graduation was significantly associated with PSM. At a median follow-up of 5.7 years, the unadjusted 5-year DS and OS were 98.4% and 94.3%, respectively. Survival did not differ by surgical margin status, with 96.2% and 92.1% 5-year DSS and OS for patients with PSM, compared to 98.7% and 94.5% for those with negative margins (p=NS by log-rank test). Using a Cox model surgical margin status was not associated with time to all-cause death (p=0.53). CONCLUSIONS: Our population-level data suggests that although PSM is fairly prevalent at 13.8%, it appears to have little to no impact on 5-year survival among patients undergoing PN for RCC. Longer follow-up is required to determine the impact of PSM in RCC. Source of Funding: None
988 COMPARISON OF RATES AND RISK FACTORS FOR DEVELOPMENT OF ANEMIA FOLLOWING RADICAL NEPHRECTOMY OR PARTIAL NEPHRECTOMY Aditya Bagrodia*, Memphis, TN; Christopher J. DiBlasio, Memphist, TN; John B. Malcolm, Reza Mehrazin, Memphis, TN; Jonathan Silberstein, Marianne Chenoweth, Tracy Downs, Christopher J Kane, Robert W. Wake, Anthony L. Patterson, Jim Y Wan, Ithaar H Derweesh, La Jolla, CA INTRODUCTION AND OBJECTIVE: Anemia is a significant cause of morbidity and mortality in chronic kidney disease. We examined the incidence and risk factors for developing anemia and requiring Erythropoiesis-stimulating agents (ESA) in patients who underwent radical nephrectomy (RN) and partial nephrectomy (NSS). METHODS: Retrospective review of 905 patients (mean age 57.5 years, mean follow-up 5.8 years) who underwent RN or NSS for renal tumors at two institutions from 7/1987 to 6/2007. Demographics, renal function and metabolic parameters [Glomerular Filtration Rate (GFR), serum bicarbonate] and history of preoperative and postoperative anemia [WHO definition: Hemoglobin (g/dL) < 13 in males and <12 in females] and ESA utilization were recorded. Data were analyzed within subgroups based on treatment (RN vs. NSS). Multivariate analysis (MVA) was conducted to elucidate risk factors for development of anemia following surgery. RESULTS: There were no significant differences with respect to mean follow-up, age, race, sex, or BMI. 610 patients underwent RN and 295 underwent NSS. Tumor size (cm) was significantly larger for RN (RN 7.0 vs. NSS 3.7, p<0.0001). No significant difference was noted with respect to preoperative anemia (RN 16.4% vs. NSS 18.6%. p=0.406) and ESA treatment (RN 0.7% vs. NSS 1.4%, p=0.292). Postoperatively, significantly less de novo anemia (NSS 4.1% vs. RN 17.5%, p=0.0006) and ESA utilization (NSS 2.7% vs. RN 13.4%, p=0.005) developed in the NSS cohort. MVA demonstrated Ageq60 (OR 1.62, p=0.008), African-American (OR 2.30, p<0.0001), smoking history (OR 1.60, p=0.13), preoperative GFR <60 mL/min/1.73m2, (OR=4.09, p<0.0001), preoperative q1+ proteinuria (OR 2.19, p=0.03), preoperative metabolic acidosis (OR=4.08, p=0.007), and RN (OR 2.58, p<0.0001) as significantly associated with de novo development of anemia. CONCLUSIONS: Patients who underwent RN had a significantly higher incidence of de novo anemia and ESA requirement in comparison to a contemporary, well-matched cohort that underwent NSS. In addition to RN, ageq60, African-American, history of smoking, GFR<60, proteinuria, and metabolic acidosis were associated with developing
THE JOURNAL OF UROLOGY®
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
353
anemia. Multivariate analysis for variables associated with development of anemia Variable Age q 60 (Yes vs. No) Race (African-American vs. Caucasian-Other) History of Smoking (Yes vs. No)
Odds Ratio 1.62
95% Confidence Interval 1.13-2.22
2.30
1.63-3.25
P value 0.008 <0.0001
1.60
1.10-2.32
0.013
Preoperative GFR < 60 (Yes vs. No)
4.09
2.11-7.94
<0.0001
Preoperative proteinuria (Yes vs. No) Preoperative Metabolic Acidosis (Yes vs. No) RN vs. NSS
2.19
1.08-4.46
0.03
4.08
1.48-11.25
0.007
2.58
1.78-3.82
<0.0001
Source of Funding: None
989 HISTOLOGICAL SUBTYPES OF LOCALIZED RENAL CELL CARCINOMA (RCC)CORRELATE WITH TUMOR SIZE: A SEER ANALYSIS Jason Rothman*, Brian L Egleston, Yu-Ning Wong, Kevan Iffrig, Steve Lebovitch, Robert G Uzzo, Philadelphia, PA INTRODUCTION AND OBJECTIVE: Histology is an important prognostic variable when counseling patients with localized RCC. We investigated the relationship between tumor size and histology in patients with localized RCC. METHODS: Data from Surveillance, Epidemiology and End Results (SEER) were used to create a cohort of patients with localized, node negative RCC (1988-2004). Multinomial logistic models were used to predict the probability of specific histologies based on increasing primary tumor size. RESULTS: 19,932 patients in SEER with localized RCC were evaluated. 88% (17,552) patients had clear cell RCC, 4.4% (865) had papillary RCC, 1.9% (388) had chromophobe RCC. A high probability of detecting clear cell RCC was found for all tumor sizes; although localized clear cell RCCs were less commonly very large (Figure 1). Papillary RCC exhibited a u-shaped relationship between histology and tumor size such that at 10 cm the probability of papillary RCC increased with increasing tumor size (Figure 2). The probability of chromophobe RCC also increased with tumor size (Figure 3). Multinomial models predict the probability of papillary vs clear cell RCC decreases with tumor size (OR=0.95 per 1 cm increase, p<0.001) while the odds of chromophobe vs clear cell RCC increases with tumor size (OR=1.08 per 1 cm increase in size, p<0.001). CONCLUSIONS: The probability of detecting particular histologies varies with increasing primary tumor size such that localized clear cell RCCs were less often very large. Additionally, the incidence of both papillary and chromophobe histologies increased with primary tumor size. These data provide insight into the basic biology of localized RCC and have implications when counseling patients with large localized renal masses.
Source of Funding: The Fox Chase Kidney Cancer Keystone Program
990 INVESTIGATION OF PREOPERATIVE SERUM C-REACTIVE PROTEIN LEVEL ON THE PROGNOSIS FOR PATIENTS WITH LOCALIZED RENAL CELL CARCINOMA Soichi Mugiya*, Seiichiro Ozono, Masao Nagata, Tatsuya Takayama, Yutaka Kurita, Hamamatsu, Japan INTRODUCTION AND OBJECTIVE: Serum level of C-reactive protein (CRP) is frequently increased in patients with cancer, and was found to be associated with the prognosis in patients with advanced renal cell carcinoma (RCC). However, there are few studies that have examined the prognostic value of CRP in patients with localized RCC. We attempted to evaluate the importance of the preoperative serum CRP level on the prognosis for patients with localized RCC. METHODS: We studied retrospectively the records of 617 patients with RCC who underwent curative resection under classification as T1-3aN0M0. Disease-free and overall survival rates were estimated using the Kaplan-Meier method, and its associations with the CRP and other clinical and pathologic features were evaluated using Cox proportional hazard model. We also examined the predictive value of CRP as a predictor for recurrence, using receiver-operator characteristic (ROC) analysis. RESULTS: T classification included T1a in 321 patients, T1b in 172, T2 in 64, and T3a in 60. Of the 617 patients, 65 patients presented recurrence of RCC during a median follow-up of 57 months (range: 1-251). Disease-free survival rates at 5 and 10 years accounted for 88 and 81%, respectively. Patients with elevated CRP levels had significantly higher pathological T stage and histological grade. The preoperative serum CRP levels in patients with recurrence (1.956±3.570) were significantly higher than those in patients with non-recurrence (0.937±3.158) (p<0.0001). Using ROC analysis, CRP threshold value of 0.25 mg/dL gave a high sensitivity and specificity for recurrence. Analysis of disease-free and