Prognostic role of systemic inflammatory response in renal cell carcinoma: a systematic review and meta-analysis

To summarize the global predicting role of systemic inflammatory response for survival in renal cell carcinoma. Eligible studies were identified and assessed for quality through multiple search strategies. Data were collected from studies comparing overall, cancer-specific or relapse-free survival in patients with elevated C-reactive protein (CRP), platelet count (PC) and erythrocyte sedimentation rate (ESR) levels with those with lower levels. Studies were pooled, and combined hazard ratios (HRs) of CRP, PC and ESR for survival were calculated, respectively. A total of 47 studies were included for meta-analysis (18 for CRP, 15 for PC and 14 for ESR). For overall survival, the pooled HR of CRP (3.23, 95% CI: 1.77, 5.89) was higher than that of PC (1.96, 95% CI: 1.40, 2.75) and that of ESR (1.86, 95% CI: 1.34, 2.59). These indicators were strong predictors for cancer-specific survival with individual HRs being 3.46 (95% CI, 2.80, 4.27) of CRP, 3.22 (95% CI, 2.25, 4.62) of PC, and 3.85 (95% CI, 3.31, 4.48) of ESR, respectively. All three inflammatory indictors also predicted relapse-free survival (HRs > 2.0). The systemic inflammatory response predicted poor survival in patients with renal cell carcinoma.