Tumor associated trypsin inhibitor as a prognostic factor in renal cell carcinoma

Purpose: We analyzed the prognostic significance of pretreatment serum tumo r associated trypsin inhibitor in renal cell carcinoma. Materials and Methods: Serum samples were obtained before surgery from 188 patients who underwent radical nephrectomy for renal cell carcinoma. Median followup of living patients was 8.5 years. Serum tumor associated trypsin inhibitor was measured by a time resolved immunofluorometric assay. Statist ical analysis was performed using the Kaplan-Meier method, log rank and str atified log rank tests. Results: Preoperatively serum tumor associated trypsin inhibitor was elevat ed with a cutoff 16 mug./l. in 48% of the patients with normal serum creati nine. The concentration in patients with cancer was significantly higher th an in controls (p <0.0001). The serum level correlated with clinical stage and nuclear grade. Patients with an elevated level had significantly shorte r survival time than those with a normal level (p = 0.005). Stratified log rank test demonstrated that tumor associated trypsin inhibitor was a progno stic factor independent of stage and grade in all patients as well as in th ose with nonmetastatic disease. Conclusions: Increased preoperative serum tumor associated trypsin inhibito r was associated with poor survival in renal cell carcinoma. The serum leve l was an independent prognostic variable. Preoperative serum tumor associat ed trypsin inhibitor appears to be a useful predictive factor that may be u sed to identify patients at increased risk of aggressive disease.