Diagnostic value of a combined C-reactive protein and haptoglobin tests in new cases of upper tract urothelial carcinoma

Serum C-reactive protein (CRP) is believed to be increased in metastatic urothelial cancer of the bladder. However, the changes depend on the stage and grade of the upper tract urothelial carcinoma (UTUC). This study aimed to compare low-range and high-range serum CRP and haptoglobin in new cases of UTUC.

Blood was collected from newly diagnosed patients with UTUC (n=43 patients; 39 male/4 female) and normal individuals (n=26; 24 male and 2 female) with no sign of infection or cancer. All the patients showed clinical symptoms of bladder cancer. Serum CRP and haptoglobin were estimated based on conventional methods.

Haematuria and polyuria were common symptoms in 65.12% of the patients suffering from UTUC. The serum level of HAPT in control and UTUC patients was 126±13 and 181±14.5 mg/dl respectively. No significant difference was observed in HAPT level in patients and controls. The HAPT was in the high-range level in 27% of controls and 30% of the patients.The average serum CRP level in patients and controls was 11.87±3.5 mg/l and 11.45±4.2 mg/l, respectively. Serum CRP was above 3.5 mg/l (>3.5 mg/l) in 46% of patients (20/43). The CRP level was significantly higher (P=0.023) in patients having CRP above 3.5 mg/l compared to respective controls.The UTUC patients were separated into two groups based on low-range (<3.5mg/l) and high-range CRP (>3.5 mg/l).Serum CRP was <3.5 mg/l in 69% of the controls, whereas 31% of controls had CRP >3.5 mg/l. However, 46% of UTUC patients had serum CRP > 3.5 mg/l and 54% of UTUC patients had serum CRP < 3.5 mg/l.

Although there was no difference in haptoglobin levels in patients and controls, but serum CRP was significantly increased in patients and it was associated with clinical symptoms of UTUC, suggesting that serum CRP can be considered as a complementary test for detection of low-grade UTUC.