MP36-06 COMBINATION OF CHARLSON COMORBIDITY INDEX AND C-REACTIVE PROTEIN IS ASSOCIATED WITH IMPROVED PROGNOSTIC PERFORMANCE COMPARED TO CHARLSON COMORBIDITY INDEX ALONE IN RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance I (MP36)1 May 2024MP36-06 COMBINATION OF CHARLSON COMORBIDITY INDEX AND C-REACTIVE PROTEIN IS ASSOCIATED WITH IMPROVED PROGNOSTIC PERFORMANCE COMPARED TO CHARLSON COMORBIDITY INDEX ALONE IN RENAL CELL CARCINOMA Julian A. Cortes, Cesare Saitta, Jonathan A. Afari, Kit L. Yuen, Dattatraya Patil, Hajime Tanaka, Mirha Mahmood, Joshua Matian, Mariam Mansour, Kevin Hakimi, Luke Wang, Margaret F. Meagher, Franklin Liu, Mimi V. Nguyen, Dhruv Puri, Clara Cerrato, Masaki Kobayashi, Shohei Fukuda, Yasuhisa Fujii, Viraj Master, and Ithaar H. Derweesh Julian A. CortesJulian A. Cortes , Cesare SaittaCesare Saitta , Jonathan A. AfariJonathan A. Afari , Kit L. YuenKit L. Yuen , Dattatraya PatilDattatraya Patil , Hajime TanakaHajime Tanaka , Mirha MahmoodMirha Mahmood , Joshua MatianJoshua Matian , Mariam MansourMariam Mansour , Kevin HakimiKevin Hakimi , Luke WangLuke Wang , Margaret F. MeagherMargaret F. Meagher , Franklin LiuFranklin Liu , Mimi V. NguyenMimi V. Nguyen , Dhruv PuriDhruv Puri , Clara CerratoClara Cerrato , Masaki KobayashiMasaki Kobayashi , Shohei FukudaShohei Fukuda , Yasuhisa FujiiYasuhisa Fujii , Viraj MasterViraj Master , and Ithaar H. DerweeshIthaar H. Derweesh View All Author Informationhttps://doi.org/10.1097/01.JU.0001008612.93052.9d.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Charlson Comorbidity Index (CCI) is the reference-standard measure to assess impact of comorbidities on survival. C-reactive protein (CRP) is an inflammatory marker associated with survival outcomes in renal cell carcinoma (RCC) and chronic kidney disease (CKD). We sought to evaluate the predictive ability of combined CCI and CRP (CCI-CRP) compared to CCI for outcomes in RCC. METHODS: We conducted a multi-center retrospective analysis. Receiver Operator Characteristics (ROC) curve analysis was fitted to identify threshold defining low-CRP (LCRP) and high-CRP (HCRP). Patients were stratified according to CCI [low CCI≤3 (LCCI); intermediate CCI 4-6 (ICCI); high CCI>6 (HCCI)] and CRP level. Kaplan-Meier analysis (KMA) was fitted to elucidate overall survival estimates for combinations of CRP level and CCI score. Based on the distributions of the survival analysis we proposed a new stratification. The proposed model's performance was assessed with ROC analysis area under the curve (AUC). Utility of the model in predicting overall (OS) and cancer-specific survival (CSS) in T1a RCC was assessed. RESULTS: 2,890 patients with a median follow up of 30 months (IQR 9.4-61.9) were analyzed. ROC analysis identified maximum product sensitivity and specificity for CRP at 3.5 mg/L. KMA revealed 5-year OS of 95% for LCCI/LCRP, 82.9% for ICCI/LCRP, 73.3% for HCCI/LCRP, 62.3% for LCCI/HCRP, 51.8% for ICCI/HCRP and 40.4% for HCCI/HCRP (p<0.001). These results allowed for a new categorization of the CCI: low CCI-CRP including LCRP/LCCI and LCRP/ICCI, intermediate CCI-CRP including LCRP/HCCI and HCRP/LCCI, and high CCI-CRP including HCRP/ICCI and HCRP/HCCI. AUC for proposed CCI-CRP classification showed improved performance relative to CCI alone in predicting all-cause mortality and cancer-specific mortality (0.76 vs. 0.62, p<0.001; 0.78 vs. 0.61, p<0.001). Testing CCI-CRP using KMA of clinical T1a RCC stratified by new CCI-CRP risk score revealed 5-year OS of 87% for low CCI-CRP, 66.6% for intermediate CCI-CRP, and 45.7% for high CCI-CRP (p<0.001). KMA revealed 5-year CSS of 96.6% for low CCI-CRP, 94.3% for intermediate CCI-CRP, and 83.3% for high CCI-CRP (p<0.001). CONCLUSIONS: CCI-CRP exhibits increased prognostic performance as compared to CCI alone in RCC and may more completely account for factors associated with survival outcomes and may also have utility in clinical decision making for surveillance versus intervention in small (T1a) renal mass. Further investigation is requisite. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e593 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Julian A. Cortes More articles by this author Cesare Saitta More articles by this author Jonathan A. Afari More articles by this author Kit L. Yuen More articles by this author Dattatraya Patil More articles by this author Hajime Tanaka More articles by this author Mirha Mahmood More articles by this author Joshua Matian More articles by this author Mariam Mansour More articles by this author Kevin Hakimi More articles by this author Luke Wang More articles by this author Margaret F. Meagher More articles by this author Franklin Liu More articles by this author Mimi V. Nguyen More articles by this author Dhruv Puri More articles by this author Clara Cerrato More articles by this author Masaki Kobayashi More articles by this author Shohei Fukuda More articles by this author Yasuhisa Fujii More articles by this author Viraj Master More articles by this author Ithaar H. Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...