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Aktuelle Urol 2013; 44(06): 452-455
DOI: 10.1055/s-0033-1358677
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Stellenwert des Serum-CRP-Wertes zur Einschätzung von Prognose und therapeutischem Ansprechen urologischer Malignome

Utility of the Serum CRP Value for Assessing the Prognosis and Therapeutic Response of Urological Malignancies
A. Köhler
1   Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover
,
H. Eggers
2   Klinik für Onkologie, Hämatologie, Hämostaseologie und Stammzelltransplantation, Medizinische Hochschule Hannover
,
M. A. Kuczyk
1   Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover
,
A. J. Schrader
3   Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm
,
S. Steffens
1   Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover
› Author Affiliations
Further Information

Publication History

Publication Date:
20 November 2013 (online)

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Zusammenfassung

Das C-reaktive Protein (CRP) ist ein unspezifischer Parameter der systemischen Entzündungsreaktion, der auch im Rahmen von Autoimmunerkrankungen, Traumata oder bei malignen Erkrankungen vermehrt exprimiert wird. Unter urologischen Karzinomerkrankungen zeigt sich für das Nierenzell- und Harnblasenkarzinom ein mehrfach belegter Zusammenhang zwischen der Höhe des CRP und dem Krankheitsverlauf bzw. der Prognose. Beim bereits metastasierten sowie kastrationsresistenten Prostatakarzinom kann das CRP zur Abschätzung des Krankheitsausmaßes und der Mortalität herangezogen werden. Der CRP-Wert scheint neben dem PSA einen weiteren unabhängigen prognostischen Marker für das tumorspezifische Überleben darzustellen, auch wenn er weder organ- noch tumorspezifisch ist. Die Bestimmung der CRP Konzentration im Serum ist als weltweit standardisierter laborchemischer Parameter routinemäßig durchführbar. Bevor allerdings das CRP im klinischen Alltag auch als etablierter Prognoseparameter angesehen werden kann, ist eine Validierung seines prognostischen und prädiktiven Wertes mittels großer, multizentrischer und vorzugsweise prospektiver Studien nötig.

Abstract

C-reactive protein (CRP) is an unspecific marker of systemic inflammation. It is known to be elevated in autoimmune disease, traumata and malignancies. Increased CRP levels have specifically been shown to be associated with disease progression and prognosis in various studies on renal cell carcinoma and transitional cell carcinoma. Although CRP, unlike PSA, is neither organ-specific nor tumour-specific, studies were able to show that increased CRP values are an independent prognostic marker for tumour-specific survival of patients with prostate cancer. In metastatic and castration-resistant prostate cancer elevated CRP levels have been approved as a useful marker to estimate the extent of disease and mortality. CRP measurements in serum are standardised worldwide and widely used in daily clinical routine. However, until CRP can be firmly established as a prognostic marker in daily routine, we need validation of its prognostic and predictive value with large and preferably prospective multicentre studies.

Schlüsselwörter

C-Reaktives Protein - Prognoseparameter - urologische Tumore - Prostatakarzinom - Nierenkrebs - Blasenkrebs

Key words

c-reactive protein - prognostic marker - urological cancer - prostate cancer kidney cancer - bladder cancer
 

  • Literatur

  • 1 Jabs WJ, Busse M, Kruger S et al. Expression of C-reactive protein by renal cell carcinomas and unaffected surrounding renal tissue. Kidney international 2005; 68: 2103-2110
    CrossrefPubMedSearch in Google Scholar
  • 2 Stark JR, Li H, Kraft P et al. Circulating prediagnostic interleukin-6 and C-reactive protein and prostate cancer incidence and mortality. International journal of cancer 2009; 124: 2683-2689
    CrossrefPubMedSearch in Google Scholar
  • 3 Karakiewicz PI, Hutterer GC, Trinh QD et al. C-reactive protein is an informative predictor of renal cell carcinoma-specific mortality: a European study of 313 patients. Cancer 2007; 110: 1241-1247
    CrossrefPubMedSearch in Google Scholar
  • 4 Mahmoud FA, Rivera NI. The role of C-reactive protein as a prognostic indicator in advanced cancer. Current oncology reports 2002; 4: 250-255
    CrossrefPubMedSearch in Google Scholar
  • 5 Weinstein PS, Skinner M, Sipe JD et al. Acute-phase proteins or tumour markers: the role of SAA, SAP, CRP and CEA as indicators of metastasis in a broad spectrum of neoplastic diseases. Scandinavian journal of immunology 1984; 19: 193-198
    PubMedSearch in Google Scholar
  • 6 Allin KH, Bojesen SE, Nordestgaard BG. Baseline C-reactive protein is associated with incident cancer and survival in patients with cancer. J Clin Oncol 2009; 27: 2217-2224
    CrossrefPubMedSearch in Google Scholar
  • 7 Heikkila K, Harris R, Lowe G et al. Associations of circulating C-reactive protein and interleukin-6 with cancer risk: findings from two prospective cohorts and a meta-analysis. Cancer Causes Control 2009; 20: 15-26
    CrossrefPubMedSearch in Google Scholar
  • 8 Canna K, McArdle PA, McMillan DC et al. The relationship between tumour T-lymphocyte infiltration, the systemic inflammatory response and survival in patients undergoing curative resection for colorectal cancer. British journal of cancer 2005; 92: 651-654
    CrossrefPubMedSearch in Google Scholar
  • 9 McMillan DC, Canna K, McArdle CS. Systemic inflammatory response predicts survival following curative resection of colorectal cancer. The British journal of surgery 2003; 90: 215-219
    CrossrefPubMedSearch in Google Scholar
  • 10 Jamieson NB, Glen P, McMillan DC et al. Systemic inflammatory response predicts outcome in patients undergoing resection for ductal adenocarcinoma head of pancreas. British journal of cancer 2005; 92: 21-23
    CrossrefPubMedSearch in Google Scholar
  • 11 Heys SD, Ogston KN, Simpson WG et al. Acute phase proteins in patients with large and locally advanced breast cancer treated with neo-adjuvant chemotherapy: response and survival. International journal of oncology 1998; 13: 589-594
    PubMedSearch in Google Scholar
  • 12 Guillem P, Triboulet JP. Elevated serum levels of C-reactive protein are indicative of a poor prognosis in patients with esophageal cancer. Dis Esophagus 2005; 18: 146-150
    CrossrefPubMedSearch in Google Scholar
  • 13 McArdle PA, Mir K, Almushatat AS et al. Systemic inflammatory response, prostate-specific antigen and survival in patients with metastatic prostate cancer. Urologia internationalis 2006; 77: 127-129
    CrossrefPubMedSearch in Google Scholar
  • 14 Van Hemelrijck M, Jungner I, Walldius G et al. Risk of prostate cancer is not associated with levels of C-reactive protein and other commonly used markers of inflammation. International journal of cancer
    PubMed
  • 15 Platz EA, De Marzo AM, Erlinger TP et al. No association between pre-diagnostic plasma C-reactive protein concentration and subsequent prostate cancer. The Prostate 2004; 59: 393-400
    CrossrefPubMedSearch in Google Scholar
  • 16 Il’yasova D, Colbert LH, Harris TB et al. Circulating levels of inflammatory markers and cancer risk in the health aging and body composition cohort. Cancer Epidemiol Biomarkers Prev 2005; 14: 2413-2418
    CrossrefPubMedSearch in Google Scholar
  • 17 Siemes C, Visser LE, Coebergh JW et al. C-reactive protein levels, variation in the C-reactive protein gene, and cancer risk: the Rotterdam Study. J Clin Oncol 2006; 24: 5216-5222
    CrossrefPubMedSearch in Google Scholar
  • 18 Twillie DA, Eisenberger MA, Carducci MA et al. Interleukin-6: a candidate mediator of human prostate cancer morbidity. Urology 1995; 45: 542-549
    CrossrefPubMedSearch in Google Scholar
  • 19 Adler HL, McCurdy MA, Kattan MW et al. Elevated levels of circulating interleukin-6 and transforming growth factor-beta1 in patients with metastatic prostatic carcinoma. The Journal of urology 1999; 161: 182-187
    CrossrefPubMedSearch in Google Scholar
  • 20 Lehrer S, Diamond EJ, Mamkine B et al. C-reactive protein is significantly associated with prostate-specific antigen and metastatic disease in prostate cancer. BJU international 2005; 95: 961-962
    CrossrefPubMedSearch in Google Scholar
  • 21 Drachenberg DE, Elgamal AA, Rowbotham R et al. Circulating levels of interleukin-6 in patients with hormone refractory prostate cancer. The Prostate 1999; 41: 127-133
    CrossrefPubMedSearch in Google Scholar
  • 22 Trichopoulos D, Psaltopoulou T, Orfanos P et al. Plasma C-reactive protein and risk of cancer: a prospective study from Greece. Cancer Epidemiol Biomarkers Prev 2006; 15: 381-384
    CrossrefPubMedSearch in Google Scholar
  • 23 Gakis G, Todenhofer T, Renninger M et al. Development of a new outcome prediction model in carcinoma invading the bladder based on preoperative serum C-reactive protein and standard pathological risk factors: the TNR-C score. BJU international 108: 1800-1805
    PubMed
  • 24 Yoshida S, Saito K, Koga F et al. C-reactive protein level predicts prognosis in patients with muscle-invasive bladder cancer treated with chemoradiotherapy. BJU international 2008; 101: 978-981
    CrossrefPubMedSearch in Google Scholar
  • 25 Johnson TV, Abbasi A, Owen-Smith A et al. Absolute preoperative C-reactive protein predicts metastasis and mortality in the first year following potentially curative nephrectomy for clear cell renal cell carcinoma. The Journal of urology 183: 480-485
    PubMed
  • 26 Grossman HB, Natale RB, Tangen CM et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. The New England journal of medicine 2003; 349: 859-866
    CrossrefPubMedSearch in Google Scholar
  • 27 Cindolo L, Patard JJ, Chiodini P et al. Comparison of predictive accuracy of four prognostic models for nonmetastatic renal cell carcinoma after nephrectomy: a multicenter European study. Cancer 2005; 104: 1362-1371
    CrossrefPubMedSearch in Google Scholar
  • 28 Karakiewicz PI, Suardi N, Capitanio U et al. A preoperative prognostic model for patients treated with nephrectomy for renal cell carcinoma. European urology 2009; 55: 287-295
    CrossrefPubMedSearch in Google Scholar
  • 29 Galfano A, Novara G, Iafrate M et al. Mathematical models for prognostic prediction in patients with renal cell carcinoma. Urologia internationalis 2008; 80: 113-123
    CrossrefPubMedSearch in Google Scholar
  • 30 Tan MH, Li H, Choong CV et al. The Karakiewicz nomogram is the most useful clinical predictor for survival outcomes in patients with localized renal cell carcinoma. Cancer 117: 5314-5324
    PubMed
  • 31 George S, Bukowski RM. Biomarkers in clear cell renal cell carcinoma. Expert review of anticancer therapy 2007; 7: 1737-1747
    CrossrefPubMedSearch in Google Scholar
  • 32 Crispen PL, Boorjian SA, Lohse CM et al. Predicting disease progression after nephrectomy for localized renal cell carcinoma: the utility of prognostic models and molecular biomarkers. Cancer 2008; 113: 450-460
    CrossrefPubMedSearch in Google Scholar
  • 33 Jagdev SP, Gregory W, Vasudev NS et al. Improving the accuracy of pre-operative survival prediction in renal cell carcinoma with C-reactive protein. British journal of cancer 103: 1649-1656
    PubMed
  • 34 Bui MH, Seligson D, Han KR et al. Carbonic anhydrase IX is an independent predictor of survival in advanced renal clear cell carcinoma: implications for prognosis and therapy. Clin Cancer Res 2003; 9: 802-811
    PubMedSearch in Google Scholar
  • 35 Ito K, Asano T, Yoshii H et al. Impact of thrombocytosis and C-reactive protein elevation on the prognosis for patients with renal cell carcinoma. Int J Urol 2006; 13: 1365-1370
    CrossrefPubMedSearch in Google Scholar
  • 36 Lamb GW, McMillan DC, Ramsey S et al. The relationship between the preoperative systemic inflammatory response and cancer-specific survival in patients undergoing potentially curative resection for renal clear cell cancer. British journal of cancer 2006; 94: 781-784
    CrossrefPubMedSearch in Google Scholar
  • 37 Casamassima A, Picciariello M, Quaranta M et al. C-reactive protein: a biomarker of survival in patients with metastatic renal cell carcinoma treated with subcutaneous interleukin-2 based immunotherapy. The Journal of urology 2005; 173: 52-55
    CrossrefPubMedSearch in Google Scholar
  • 38 Fujikawa K, Matsui Y, Oka H et al. Serum C-reactive protein level and the impact of cytoreductive surgery in patients with metastatic renal cell carcinoma. The Journal of urology 1999; 162: 1934-1937
    CrossrefPubMedSearch in Google Scholar
  • 39 Komai Y, Saito K, Sakai K et al. Increased preoperative serum C-reactive protein level predicts a poor prognosis in patients with localized renal cell carcinoma. BJU international 2007; 99: 77-80
    CrossrefPubMedSearch in Google Scholar
  • 40 Bui MH, Visapaa H, Seligson D et al. Prognostic value of carbonic anhydrase IX and KI67 as predictors of survival for renal clear cell carcinoma. The Journal of urology 2004; 171: 2461-2466
    CrossrefPubMedSearch in Google Scholar
  • 41 Lee SE, Byun SS, Han JH et al. Prognostic significance of common preoperative laboratory variables in clear cell renal cell carcinoma. BJU international 2006; 98: 1228-1232
    CrossrefPubMedSearch in Google Scholar
  • 42 Steffens S, Köhler A, Rudolph R et al. Validation of CRP as prognostic marker for renal cell carcinoma in a large series of patients. BMC Cancer 2012; 12: 399
    CrossrefPubMedSearch in Google Scholar
  • 43 Stein B, Schrader AJ, Wegener G et al. Preoperative serum C-reactive protein: a prognostic marker in patients with upper urinary tract urothelial carcinoma. BMC Cancer 2013; 13: 101
    CrossrefPubMedSearch in Google Scholar
  • 44 Steffens S, Al Ghazal A, Steinestel J et al. High CRP values predict poor survival in patients with penile cancer. BMC Cancer 2013; 13: 223
    CrossrefPubMedSearch in Google Scholar