Preoperative C-reactive protein as a prognostic predictor for upper tract urothelial carcinoma: A systematic review and meta-analysis

Abstract

Upper tract urothelial carcinoma (UTUC) is a relatively rare and highly aggressive tumor. However, the prognosis of UTUC is rarely predicted accurately due to the lack of reliable biomarkers. C-reactive protein (CRP) has been found to be correlated with several types of cancer. In this study, we performed a systematic review and meta-analysis to determine the association between CRP levels and prognosis in UTUC. A computerized search was conducted through PubMed, Embase, Web of Science, the Cochrane Library and CBM databases to identify clinical studies that have evaluated the association between preoperative CRP levels and prognosis of UTUC. The prognostic outcomes included recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). We extracted and synthesized corresponding hazard ratios (HRs) and confidence intervals (CIs) using Review Manager 5.3 software. We identified 7 retrospective cohort studies including a total of 1,919 patients and analyzed these studies using univariate and multivariate models. Our meta-analysis results revealed that RFS and CSS were significantly different between patients with elevated CRP levels and those with low CRP levels (P<0.0001 and P<0.00001, respectively); however, that was not the case for OS (P=0.22) in the multivariate or the univariate model. The pooled HR of RFS was 2.90 (95% CI: 1.87-4.51, P<0.00001) in the univariate analysis and 1.57 (95% CI: 1.26-1.97, P<0.0001) in the multivariate analysis. The pooled HRs of CSS were 2.78 (95% CI: 1.75-4.43, P<0.0001) and 1.64 (95% CI: 1.32-2.03, P<0.00001) in the univariate and multivariate analysis, respectively. However, the pooled HRs of OS were not significant in the univariate [1.24 (95% CI: 0.72-2.15, P=0.43)] or the multivariate analysis [1.24 (95% CI: 0.88-1.75, P=0.22)]. In conclusion, our meta-analysis results suggested that CRP level may be a prognostic predictor in UTUC.

Prognostic Role of Preoperative C-Reactive Protein in Upper Tract Urothelial Carcinoma after Radical Nephroureterectomy - An Updated Meta-Analysis

“…And there was no signi cant publication bias which existed in FRS, CCS and OS, respectively (Begg's test: P = 0.089, P = 0.592, P = 0.089). Compared with You L and his colleagues' study [9], we recon rmed that elevated preoperative CRP had a poor impact on RFS and CCS of patients with UTUC and found elevated CRP also played a signi cant adverse effect on OS in patients with UTUC treated by RNU, which greatly differed from theirs. On the basis of their research, in which there were 2 studies [3,24] only containing outcomes in the univariate analysis, we retrieved another 8 relevant studies [12][13][14][15][16][17][18][19] including sound results in multivariate analysis, and, since then, 1233 cases were added to our studies.…”

Risk stratification for kidney sparing procedure in upper tract urothelial carcinoma

“…Cytology, biopsy grading and imaging should be combined to reach high negative predictive value for muscle invasive disease or higher stage ( 26 ). In the same way, positive exfoliated cell cytology increased the accuracy of biopsy grade in determining the presence of advanced-stage UTUC ( 28 , 29 ). The combination of these different information may be useful to overcome their current limitations.…”

Prognostic role of the preoperative serum albumin : globulin ratio after radical nephroureterectomy for upper tract urothelial carcinoma

“…Gamma GLB, also known as immunoglobulins or antibodies, are secreted by the B cells of the adaptive immune system; hence, they play important roles in immunity. As a biomarker of systemic inflammation, an elevated CRP level has been considered as a prognostic factor in urological cancers . Evidence is accumulating that shows that the presence of a systemic inflammatory response is associated with poor survival in patients with a variety of malignancies .…”

“…As a biomarker of systemic inflammation, an elevated CRP level has been considered as a prognostic factor in urological cancers. 24,25 Evidence is accumulating that shows that the presence of a systemic inflammatory response is associated with poor survival in patients with a variety of malignancies. 26,27 Indeed, a high preoperative GLB level was an unfavorable factor in patients with rectal cancer.…”