C-Reactive Protein as a Clinically Useful Biomarker of Metastasis of Renal Cell Carcinoma
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CASE REPORT
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C-Reactive Protein as a Clinically Useful Biomarker of Metastasis of Renal Cell Carcinoma Timothy V. Johnson,1 Andrew N. Young,2,3 Adeboye O. Osunkoya2,3 and Viraj A. Master1,3 1 Department of Urology, Emory University, Atlanta, Georgia, USA 2 Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA 3 Winship Cancer Institute, Atlanta, Georgia, USA
Abstract
C-reactive protein (CRP) is an acute-phase reactant that can increase dramatically in response to a variety of pathologic states. Elevated pre- and postoperative CRP levels have been associated with an increased tumor burden and metastasis in kidney cancer. We report on a case that serves to highlight a potentially novel use for CRP monitoring in the postoperative management of renal cell carcinoma. Recently, we treated a patient who presented with a localized renal cell carcinoma and an elevated preoperative CRP level. Surgical pathology demonstrated negative surgical margins and absence of nodal metastasis. Postoperatively, the patient’s serum CRP levels remained relatively low, consistent with his continued negative staging on CT scans. However, at 6 months postoperatively, the patient’s CRP level increased 13-fold. His subsequent CT scan revealed ‘‘multiple pulmonary nodules consistent with progression of metastatic disease.’’ This case demonstrates the potential for monitoring CRP in addition to, or instead of, standard restaging imaging.
1. Case Report Recently, we treated a patient who presented with a localized renal cell carcinoma. Prior to surgery, we measured his inflammatory status for prognosis and patient counseling by measuring serum C-reactive protein (CRP). His initial preoperative CRP level measured 12.07 mg/L (table I). Postoperatively, the pathology report demonstrated negative surgical margins and an absence of nodal metastasis. The patient was followed postoperatively at 1, 3, and 6 months. At each visit, CT scans were performed for restaging, consistent with the standard of care. In addition, serum CRP levels were measured. The patient’s CRP levels remained relatively low for the first 3 postoperative months, consistent with his continued negative staging on CT scans. However, at 6 months postoperatively, the patient’s CRP level increased 13-fold. A subsequent CT scan revealed ‘‘multiple pulmonary nodules consistent with progression of metastatic disease.’’
tomy, 30% of patients who present with localized disease will develop postoperative metastases.[2] After the initial staging, postoperative recurrence represents a significant prognostic factor.[3] Patients who develop metastases have a median overall survival time of 16–23 months and an overall 5-year survival rate of approximately 10%, while patients who do not develop metastases have an overall 5-year survival rate of >90%, depending on the stage.[2,4] Despite this poor prognosis, in selective cases aggressive excision of metastases following early detection can dramatically improv
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