학술논문
Creatinine to Cystatin-C Ratio in Renal Cell Carcinoma: A Clinically Pragmatic Prognostic Factor and Sarcopenia Biomarker
Document Type
Report
Author
Source
The Oncologist. December, 2023, Vol. 28 Issue 12, pe1219, 11 p.
Subject
Language
English
ISSN
1083-7159
Abstract
Introduction: Low creatinine to cystatin-C ratio (Cr/Cys-C) may be a biomarker for low-muscle mass. Furthermore, low Cr/Cys-C is associated with decreased overall survival (OS), but to date, has not been examined in patients with renal cell carcinoma (RCC). Our objective is to evaluate associations between low Cr/Cys-C ratio and OS and recurrence- free survival (RFS) in patients with RCC treated with nephrectomy. Methods: We performed a retrospective review of patients with RCC treated with nephrectomy. Patients with end- stage renal disease and less than 1-year follow up were excluded. Cr/Cys-C was dichotomized at the median for the cohort (low vs. high). OS and RFS for patients with high versus low Cr/Cys-C were estimated with the Kaplan-Meier method, and associations with the outcomes of interest were modeled using Cox proportional Hazards models. Associations between Cr/Cys-C and skeletal muscle mass were assessed with correlations and logistic regression. Results: A total of 255 patients were analyzed, with a median age of 64. Median (IQR) Cr/Cys-C was 1 (0.8-1.2). Low Cr/Cys-C was associated with age, female sex, Eastern Cooperative Oncology Group Performance Status [greater than or equal to] 1, TNM stage, and tumor size. Kaplan-Meier and Cox regression analysis demonstrated an association between low Cr/Cys-C and decreased OS (HR = 2.97, 95%CI, 1.12-790, P =0.029) and RFS (HR = 3.31, 95%CI, 1.26-8.66, P = .015). Furthermore, a low Cr/Cys-C indicated a 2-3 increase in risk of radiographic sarcopenia. Conclusions: Lower Cr/Cys-C is associated with inferior oncologic outcomes in RCC and, pending validation, may have utility as a serum biomarker for the presence of sarcopenia in patients with RCC treated with nephrectomy. Key words: renal cell carcinoma (RCC); nephrectomy; survival; sarcopenia; body composition; biomarker.
Implications for Practice Creatinine and cystatin-C are 2 routine markers of kidney function obtained from blood samples. A ratio of creatinine to cystatin-C may offer a clinically practical method to [...]
Implications for Practice Creatinine and cystatin-C are 2 routine markers of kidney function obtained from blood samples. A ratio of creatinine to cystatin-C may offer a clinically practical method to [...]