Abstract
Background
Reliable biomarkers for predicting tumor aggressiveness and pathological upstaging in renal cell carcinoma (RCC) remain limited. DR-70, a biomarker reflecting circulating fibrin and fibrin degradation products, has been associated with tumor progression in several malignancies. This study aimed to investigate the association between preoperative serum DR-70 levels and pathological stage and nuclear grade in patients with localized RCC.Methods
This prospective single-center study included 69 patients who underwent partial or radical nephrectomy for localized RCC. Tumors were staged according to the TNM classification and graded using the World Health Organization/International Society of Urological Pathology system. Preoperative serum DR-70 levels were measured, and their associations with clinical stage, pathological stage, and nuclear grade were evaluated. Multivariate logistic regression analysis was performed to identify independent predictors of pathological upstaging (≥ pT3). Receiver operating characteristic curve analysis was used to assess the predictive performance of DR-70.Results
The median serum DR-70 level was 0.84 U/mL. DR-70 levels were significantly higher in high-grade tumors than in low-grade tumors (1.32 vs. 0.78 U/mL, p = 0.001). No significant association was observed between DR-70 levels and clinical stage (p = 0.53), whereas a significant association was found with pathological stage (p = 0.023). Multivariate analysis identified serum DR-70 as an independent predictor of pathological upstaging (≥ pT3) (odds ratio 1.40; 95% confidence interval 1.09-1.81; p = 0.008). Receiver operating characteristic analysis demonstrated good predictive performance for high-grade disease (area under the curve 0.823) and pathological upstaging (area under the curve 0.774), with an optimal cutoff value of 1.02 U/mL.Conclusions
Serum DR-70 was associated with tumor aggressiveness and independently predicted pathological upstaging in patients with localized RCC. These findings suggest that DR-70 may serve as a complementary biomarker for preoperative risk stratification and may help identify patients at increased risk of aggressive pathological features. Larger multicenter studies are warranted to validate these findings.