Supplementary Material for: Preoperative C-Reactive Protein Values as a Potential Component in Outcome Prediction Models of Metastasized Renal Cell Carcinoma Patients Receiving Cytoreductive Nephrectomy

<b><i>Purpose:</i></b> To validate preoperative C-reactive protein (CRP) levels as a prognostic marker for survival in a metastasized renal cell carcinoma (mRCC) patient cohort receiving cytoreductive nephrectomy (CN). <b><i>Patients and Methods:</i></b> By chart review, 146 mRCC patients receiving CN at our tertiary referral centre from 1997 to 2015 were identified retrospectively. All relevant clinicopathological features including laboratory parameters were collected and correlated to overall survival, progression-free survival and cancer-specific survival (CSS). The mean follow-up was 23 months (range 1-168 months). <b><i>Results:</i></b> Besides the already established scoring systems like the MSKCC criteria, an elevated preoperative CRP level (≥0.5 mg/dL) was an independent predictor of CSS in our study group including the chosen postoperative adjuvant therapies (TKI vs. immunotherapy vs. others). With regard to morbidity, patients with a good performance status, small tumour size and adequate renal function/haematopoiesis experienced less complication rates, thereby profiting more from CN. <b><i>Conclusions:</i></b> Our data provide indication that preoperative CRP levels should be implemented in nomograms regarding the outcome prediction in mRCC to identify candidates likely to profit from CN.

**研究目的：** 验证术前C反应蛋白（C-reactive protein, CRP）水平作为接受减瘤性肾切除术（cytoreductive nephrectomy, CN）的转移性肾细胞癌（metastasized renal cell carcinoma, mRCC）患者队列的生存预后标志物的有效性。
**患者与方法：** 经病历回顾，本研究回顾性纳入1997年至2015年间于本三级转诊中心接受减瘤性肾切除术的146例转移性肾细胞癌患者。收集所有相关临床病理特征及实验室指标，并将其与总生存期、无进展生存期及癌症特异性生存期（cancer-specific survival, CSS）进行相关性分析。本研究的平均随访时长为23个月（范围1~168个月）。
**研究结果：** 除纪念斯隆凯特琳癌症中心（Memorial Sloan Kettering Cancer Center, MSKCC）评分标准等已确立的评分体系外，术前C反应蛋白水平升高（≥0.5 mg/dL）是本研究队列中接受不同术后辅助治疗方案（酪氨酸激酶抑制剂（Tyrosine Kinase Inhibitor, TKI）、免疫治疗及其他方案）患者的癌症特异性生存期的独立预测因子。在并发症发生情况方面，体能状态良好、肿瘤体积较小且肾功能与造血功能良好的患者并发症发生率更低，从而从减瘤性肾切除术中获益更多。
**研究结论：** 本研究数据表明，在针对转移性肾细胞癌患者的预后预测列线图（nomograms）中，应纳入术前C反应蛋白水平，以准确识别出更有可能从减瘤性肾切除术中获益的候选患者。