E-Mail karger@karger.com Original Paper Urol Int 2014;92:270–275 DOI: 10.1159/000353401 Prognostic Impact of Intratumoral C-Reactive Protein Expression in Patients with Clear Cell Renal Cell Carcinoma Cavit Can a Mustafa Fuat Acikalin b Ata Ozen a Emine Dundar b Departments of a Urology and b Pathology, Eskişehir Osmangazi University Medical Faculty, Eskişehir, Turkey than patients with a negative CRP score. Conclusion: Our re- sults suggest that the assessment of intratumoral CRP ex- pression may be a useful tool for predicting the prognosis in patients with clear cell renal cell carcinoma. © 2013 S. Karger AG, Basel Introduction About 2% of all new cancers worldwide originate in the kidney, and clear cell renal cell carcinoma (ccRCC) is the most common subtype of adult kidney cancer [1]. In 2010, it is estimated that 58240 new RCC cases were di- agnosed in the United States and 13040 deaths occurred [2]. The clinical course of ccRCC is related to some extent to a number of clinicopathological factors, including his- tologic tumor necrosis, sarcomatoid differentiation, Fuhrman nuclear grade and TNM staging parameters (tumor size, local tumor extension, lymph node involve- ment, large vessel invasion, adrenal invasion, distant me- tastases). Unfortunately, these factors are not entirely re- liable in predicting the clinical course in patients with ccRCC. For example, there are reports that have docu- mented the metastatic potential of even low-grade, early- stage ccRCC [3]. Therefore, it is clinically important to Key Words Renal cell carcinoma · C-reactive protein · Tumoral expression · Prognosis Abstract Background: Elevated serum C-reactive protein (CRP) level has been demonstrated to predict poorer survival of both localized and metastatic renal cell carcinoma. However, the prognostic value of intratumoral CRP expression has not been sufficiently studied. Patients and Methods: In the pres- ent study, the expression of CRP was evaluated with immu- nohistochemical analysis in 127 patients who had under- gone curative surgery for clear cell renal cell carcinoma. CRP staining was scored using the immunoreactivity score. An immunoreactivity score of 4 (median value) or lower was considered negative, a score higher than 4 was considered positive CRP expression. Results: Univariate analysis re- vealed that Fuhrman grade, necrosis, vascular invasion, TNM stage and CRP expression were associated with tumor-spe- cific survival. Multivariate analysis using the Cox proportion- al hazards regression method revealed only TNM stage as an independent predictor of tumor-specific survival (p = 0.001). A trend towards significance (p = 0.066) was observed with CRP expression, but it did not reach significance. Patients with a positive CRP score were 3.46 times more likely to die Received: December 6, 2012 Accepted after revision: May 30, 2013 Published online: December 19, 2013 Internationalis Urologia Dr. Mustafa Fuat Acikalin Gültepe mah. Üniversite evleri C5 Blok Daire 4 Eskişehir (Turkey) E-Mail acikalin  @  ogu.edu.tr © 2013 S. Karger AG, Basel 0042–1138/13/0923–0270$38.00/0 www.karger.com/uin