Abstract

Introduction: A few biological markers have been described in the diagnosis and follow-up of renal cell

carcinomas (RCCs). However, almost all of these markers have low sensitivity and low specificity. Ferritin is

an intracellular protein which plays role in iron storage and detoxification of the metabolites. The aim of this

study was to investigate serum ferritin levels of patients with RCC who were treated with radical

nephrectomy.

Materials and Methods: Between January 1998 and February 2005, a total 117 patients who underwent

radical nephrectomy for RCC were included into the study. Of these patients 91 (Group I) had preoperative

and postoperative ferritin determination. Control group (Group II) consisted of 39 healthy men. Patients were

evaluated with physical examination, chest X-Ray, blood chemistry studies, abdominopelvic computerized

tomography, and renal Doppler ultrasonography or bone scanning if necessary. Preoperative and

postoperative ferritin levels within Group I and ferritin levels between the groups were compared statistically.

Serum ferritin levels according to nuclear grade distribution in pathologic specimens were also compared

within group I patients.

Results: The mean age of the patients in Group I was 64.4±15.6 (range 16-80, median age: 57.2) years, and

the mean follow-up period was 47±18.4 (range 5-92, median follow-up: 25.8) months. The mean age of the

patients in Group II was 32.8±14.2 (range 23-51, median age: 29.8) years. The mean preoperative and

postoperative serum ferritin levels for Group I were 247.51±209.38 (range 17.20-925) ng/ml and 131.49±86.38

(range 21-604) ng/ml, respectively (p=0.001). The mean serum ferritin levels in control group was 82.11±43.81

(range 26-194) ng/ml. The difference between preoperative mean serum ferritin levels of Group I and control

group was statistically significant (p=0.03). There was a decline in serum ferritin levels of Group I patients in

the early postoperative period and the difference between preoperative and postoperative means was

statistically significant (p=0.001). In addition serum ferritin levels of patients with advanced stage RCC were

elevated significantly. The preoperative serum ferritin levels for all stages of RCC in Group I were as follows;

stage I: 94.36 (range 17.9-394) ng/ml, stage II: 193.72 (range 118-491) ng/ml, stage III: 279.33 (range 120-470)

ng/ml and stage IV: 568.5 (range 226-925) ng/ml and the postoperative means for all stages were 76.58 (range

11-290) ng/ml, 116.8 (range 39-176) ng/ml, 185.6 (range 126-464) ng/ml and 308.17 (range 114-604) ng/ml,

respectively. The difference between preoperative and postoperative serum ferritin levels of stage II, III and

IV RCC patients were statistically significant (p<0.05). In the evaluation of serum ferritin levels according to

nuclear grade, the difference in grade IV patients was significant when compared to grade I, II and III

patients. During the follow-up period 17 (19.78%) patients were lost because of disease.

Conclusion: Serum ferritin levels may be used in the diagnosis and follow-up of patients with RCC.

Especially in the advanced stages of the disease, its value as a marker for prognosis and survey may be

advocated.