***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To determine whether preoperative laboratory values are independently associated with death from clinical ly confined clear cell renal cell carcinoma ( RCC ) after radical nephrectomy . METHODS We identified 1707 patients with clinical ly confined ( pNx/pN0 , pM0 ) , unilateral , sporadic clear cell RCC treated with radical nephrectomy between 1970 and 2002 . Associations of abnormal preoperative laboratory values including hypercalcemia , anemia , elevated erythrocyte sedimentation rate ( ESR ) , and elevated alkaline phosphatase with death from RCC were evaluated using Cox proportional hazards regression models , both univariately and multivariately by adjusting for known prognostic features of the 2002 primary tumor classification , tumor size , nuclear grade , and coagulative tumor necrosis . RESULTS At last follow-up , 1009 patients had died , including 425 who  died  from RCC at a median of 3.0 years after surgery ( range , 0 to 26 years ) . Even after adjusting for known prognostic features , 9 % of patients with preoperative hypercalcemia exhibited significantly increased likelihood of dying from RCC compared with patients with normal or lower levels of serum calcium ( relative ration [ RR ] 1.64 ; P = 0.002 ) . Similarly , preoperative anemia ( 35 % of patients ; RR 1.27 ; P = 0.026 ) and elevated ESR ( 44 % of patients ; RR 1.66 ; P = 0.003 ) portended an increased risk of death from RCC even after multivariate adjustment . CONCLUSIONS Abnormal preoperative laboratory values including hypercalcemia , anemia , and elevated ESR are independently associated with increased risk of cancer-specific death from clinical ly confined clear cell RCC . Consideration of these variables in future models may improve prognostic accuracy . We believe these factors should be routinely assessed and included in prospect i ve studies of outcome in RCC patients 
    Output:
    
Conclusion The systemic inflammatory response predicted poor survival in patients with renal cell carcinoma