Preoperative serum cystatin-C as a potential biomarker for prognosis of renal cell carcinoma

Abstract

PurposeThe prognostic value of serum cystatin-C (Cys-C) in renal cell carcinoma (RCC) remains unknown. The purpose of this study is to explore the prognostic value of Cys-C for RCC patients.Patients and methodsThe levels of preoperative Cys-C, creatinine (CRE) and estimated glomerular filtration rate (e-GFR) were retrospectively collected in 325 RCC patients undergoing surgery. The cutoff values of Cys-C, CRE and e-GFR were determined by the standardized Cutoff Finder algorithm. The receiver operating characteristic (ROC) curve and pairwise comparison were performed to compare the three variables. Univariate and multivariate Cox regression analyses were performed to investigate the prognostic value of serum Cys-C in RCC.ResultsBased on the analysis of Cutoff Finder algorithm, ROC curve and pairwise comparison, the preoperative Cys-C was superior to CRE and e-GFR as a predictive factor in RCC. Multivariate Cox regression analyses showed that high preoperative Cys-C (>1.09 mg/L) was significantly associated with shorter overall survival (OS) in all RCC patients (hazard ratio [HR], 1.59; P = 0.012), patients at pT1-2 (P<0.001), pN0 (P<0.001) and pM0 stages (P<0.001). Moreover, Multivariate Cox regression analyses also showed that in the 306 patients without metastasis, high preoperative Cys-C was also associated with shorter disease-free survival (DFS) (HR, 3.50; P = 0.013).ConclusionsAn elevated preoperative Cys-C level was demonstrated to be related with worse survival in patients with RCC. Measuring preoperative serum Cys-C might be a simple way for finding poor prognostic patients and patients with elevated preoperative Cys-C level should be more closely followed up.

Searching for prognostic biomarkers for small renal masses in the urinary proteome

“…33 The same group showed that elevated preoperative CST3 serum levels were associated with poor survival in RCC. 34 This aligns with our study as patients with elevated CST3 expression had significantly worse OS. Another study found that HSPE1 expression was significantly downregulated in ccRCC tissues compared to adjacent normal kidney tissues.…”

“…Recently, elevated CST3 expression was found to be associated with poor prognosis in ccRCC . The same group showed that elevated preoperative CST3 serum levels were associated with poor survival in RCC . This aligns with our study as patients with elevated CST3 expression had significantly worse OS.…”

The prognostic significance of NLR in non-metastatic renal cell carcinoma undergoing nephrectomy, A meta-analysis

“…The association between chronic inflammation and cancer are duplex, inflammation can induce tumorigenesis and metastasis by affect cell proliferation, death, and angiogenesis through elevate the levels of cytokines, nuclear factor κB (NF-κB), prostaglandins and micro RNAs.et al, tumors also can induce inflammatory reactions through express cytokines that recruit neutrophils and macrophages [24] . Recent study have indicated that NLR is an indicator of systemic inflammation and general immune response of the cancer [25,26] . Although there are some other systemic inflammation reaction biomarkers, such as CRP , cystatin-C and PLR , were reported to be used for prognostic indexes in RCC [9][27] .…”

Clinical Role, Diagnostic and Prognostic Value of Human Cystatin C Through the Body

“…As a member of cysteine protease inhibitors, Cystatin C also inhibits tumor invasion and metastasis 17 .…”

“…An elevated preoperative Cystatin C level was demonstrated to be related with worse survival in patients with renal cell carcinoma. Measuring preoperative serum Cystatin C seems to be an effortless way for finding poor prognostic patients and patients with elevated preoperative Cystatin C level should be more closely followed up 17 .…”