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Objective: This study aimed to investigate the impact of elevated CRP on survival outcomes in small renal masses (SRM). Methods: This was a multi-institutional retrospective analysis of SRM (≤3 cm) managed surgically. The cohort was divided into elevated CRP (≥0.5 mg/dL) vs. non-elevated CRP groups (<0.5). The primary outcome was all-cause mortality (ACM). The secondary outcomes were non-cancer (NCM) and cancer-specific mortality (CSM). Cox-regression analysis was used to elucidate predictive factors for mortality outcomes. Kaplan–Meier Analysis (KMA) was performed to analyze 10-year overall (OS), cancer-specific (CSS) and non-cancer-specific survival (NCS). Results: A total of 1001 patients were analyzed (309 non-elevated CRP/692 elevated CRP; median follow-up 70 months). Elevated CRP was an independent predictor for ACM (HR = 2.60, p < 0.001) NCM (HR = 2.90, p = 0.002), and CSM (HR = 1.20, p = 0.011). KMA comparing elevated vs. non-elevated groups revealed greater 10-year OS (p < 0.001) and NCS (p < 0.001) for non-elevated CRP, but no significant difference in 10-year CSS (p = 0.295). A total of 83 deaths were observed in elevated CRP (71 NCM/12 CSM—all clear-cell histology). The sensitivity/specificity of elevated CRP was 0.87/0.33, 0.75/0.81, and 0.90/0.33 for ACM, CSM, and NCM. By utilizing CRP for a decision-making algorithm prioritizing biopsy in CRP elevation and offering surveillance in benign or indolent histology, surgery may be avoided in 218 patients, in whom there were 38 fatalities, all NCM. Conclusions: Elevated CRP was an independent predictor of survival outcomes in SRM ≤ 3 cm. From a competing mortality standpoint, patients with elevated CRP had significantly worsened NCM compared to CSM. In such patients, upfront oncologic risk stratification through biopsy may be considered, and indolent/low-grade neoplasms should be strongly considered for non-surgical management.
Meagher et al. (2026) studied this question.