Abstract
Purpose
The purpose of this study was to evaluate the predictive and prognostic role of preoperative
thrombocytosis (TC) in upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy
(RNU) in a large multi-institutional cohort of patients.
Methods
Records of 2492 patients undergoing RNU for non-metastatic UTUC between 1990 and 2008
were retrospectively analyzed. Preoperative TC was defined as a platelet count > 400 ×
109/L, irrespective of gender type. Logistic regression analyses were performed to evaluate
its association with pathologic features. Cox proportional hazards regression was
used for estimation of recurrence-free survival, cancer-specific survival, and overall
survival.
Results
Preoperative TC was found in 309 (12.4%) patients and was associated with advanced
tumor stage and grade, lymph node metastasis, lymphovascular invasion, tumor architecture,
necrosis, and concomitant carcinoma in situ (P-values ≤ .027). Preoperative TC independently predicted ≥ pT2 (P < .001), non–organ-confined (P < .001), and lymph node-positive (P < .001) disease in a preoperative model that adjusted for the effects of age, gender,
location, multifocality, and tumor architecture. Within a median follow-up of 45 months,
recurrence occurred in 663 (26.6%) patients with 545 (21.9%) dying of UTUC. In univariable
Cox proportional hazard regression analysis, TC was significantly associated with
recurrence-free survival (hazard ratio [HR], 1.32; P = .015) and overall survival (HR, 1.4; P < .001), but not cancer-specific survival (HR, 1.17; P = .2). In both pre- and postoperative multivariable models, when adjusted for the
effects of standard clinicopathologic features, TC did not retain its association
with survival outcomes.
Conclusions
Preoperative TC is associated with adverse clinicopathologic features and predicts
worse pathology at RNU. Among other serum biomarkers, TC could benefit preoperative
risk stratification and help guide treatment decisions.
Keywords
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References
- European Association of Urology Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma: 2015 Update.Eur Urol. 2015; 68: 868-879
- Risk of cancer-specific mortality following recurrence after radical nephroureterectomy.Ann Surg Oncol. 2012; 19: 4337-4344
- Predicting clinical outcomes after radical nephroureterectomy for upper tract urothelial carcinoma.Eur Urol. 2012; 61: 818-825
- Preoperative multivariable prognostic model for prediction of nonorgan confined urothelial carcinoma of the upper urinary tract.J Urol. 2010; 184: 453-458
- Upper urinary tract disease: what we know today and unmet needs.Transl Androl Urol. 2015; 4: 261-272
- Prognostic factors in upper urinary tract urothelial carcinomas: A comprehensive review of the current literature.Eur Urol. 2012; 62: 100-114
- Challenges of cancer biomarker profiling.Eur Urol. 2007; 52: 1601-1609
- The prognostic value of hematological and systemic inflammatory disorders in invasive bladder cancer.Curr Opin Urol. 2011; 21: 428-433
- Biomolecular predictors of urothelial cancer behavior and treatment outcomes.Curr Urol Rep. 2012; 13: 122-135
- Tumor-platelet interaction in solid tumors.Int J Cancer. 2012; 130: 2747-2760
- Preoperative C-reactive protein in the serum: a prognostic biomarker for upper urinary tract urothelial carcinoma treated with radical nephroureterectomy.Urol Int. 2014; 93: 352-360
- Impact of preoperative anemia on oncologic outcomes of upper tract urothelial carcinoma treated with radical nephroureterectomy.J Urol. 2014; 191: 316-322
- Promising role of preoperative neutrophil-to-lymphocyte ratio in patients treated with radical nephroureterectomy.World J Urol. 2017; 35: 121-130
- Prognostic relevance of postoperative platelet count in upper tract urothelial carcinoma after radical nephroureterectomy.Eur J Cancer. 2014; 50: 2583-2591
- Impact of preoperative thrombocytosis on pathological outcomes and survival in patients treated with radical cystectomy for bladder carcinoma.Anticancer Res. 2014; 34: 3225-3230
- A new prognostic model for cancer-specific survival after radical cystectomy including pretreatment thrombocytosis and standard pathological risk factors.BJU Int. 2012; 110: E533-E540
- Association of perioperative blood transfusion with oncologic outcomes after radical nephroureterectomy for upper tract urothelial carcinoma.Eur J Surg Oncol. 2014; 40: 1693-1699
- The effect of tumor location on prognosis in patients treated with radical nephroureterectomy at Memorial Sloan-Kettering Cancer Center.Eur Urol. 2010; 58: 574-580
- Macroscopic sessile tumor architecture is a pathologic feature of biologically aggressive upper tract urothelial carcinoma.Urol Oncol. 2012; 30: 666-672
- The impact of tumor multifocality on outcomes in patients treated with radical nephroureterectomy.Eur Urol. 2012; 61: 245-253
- Oncological outcomes after laparoscopic and open radical nephroureterectomy: Results from an international cohort.BJU Int. 2011; 108: 406-412
- Death certificates are valid for the determination of cause of death in patients with upper and lower tract urothelial carcinoma.Eur Urol. 2012; 61: 854-855
- Does preoperative platelet count and thrombocytosis play a prognostic role in patients undergoing nephrectomy for renal cell carcinoma? Results of a comprehensive retrospective series.World J Urol. 2013; 31: 1309-1316
- Thrombocytosis portends adverse prognostic significance in patients with stage II colorectal carcinoma.F1000Res. 2014; 3: 180
- Impact of preoperative thrombocytosis on the survival of patients with primary colorectal cancer.World J Surg. 2012; 36: 192-200
- Paraneoplastic thrombocytosis in ovarian cancer.N Engl J Med. 2012; 366: 610-618
- The prognostic significance of thrombocytosis in epithelial ovarian carcinoma.Gynecol Oncol. 2004; 92: 211-214
- Significance of thrombocytosis for determining prognosis in patients with localized renal cell carcinoma.Urology. 2004; 63: 447-450
- Prognostic value of thrombocytosis in renal cell carcinoma.J Urol. 2006; 175: 859-863
- Clinical significance of platelet count in patients with renal cell carcinoma.Urol Int. 2007; 79: 111-116
- Thrombocytosis associated with poor prognosis in patients with esophageal carcinoma.J Am Coll Surg. 2004; 198: 737-741
Article info
Publication history
Published online: June 19, 2017
Accepted:
June 13,
2017
Received in revised form:
June 9,
2017
Received:
February 22,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
