O'Keefe S Casey, Marshall Fray F, Issa Muta M, Harmon Mary P, Petros John A
Department of Urology, Emory University School of Medicine, Emory Winship Cancer Cener and Atlanta Veterans Affairs Medical Center, Georgia, USA.
J Urol. 2002 Oct;168(4 Pt 1):1378-80. doi: 10.1016/S0022-5347(05)64453-9.
We have previously reported that patients with advanced renal cell carcinoma and a normal platelet count of 400,000/mm. have a 64% increase in life expectancy compared with those with thrombocytosis. We determined whether thrombocytosis was predictive of death from renal cell carcinoma after radical nephrectomy was performed with curative intent for early stage disease.
We reviewed the records of 204 patients with renal cell carcinoma who underwent radical nephrectomy with curative intent between June 1993 and January 2000 at Emory University Hospital. Survival, pathological grade and stage were recorded from the Emory Winship Cancer Institute tumor registry. Platelet counts were recorded and any patient with at least 1 platelet count of greater than 400,000/mm. was classified with thrombocytosis. Those with a platelet count of 400,000/mm. were classified with a normal platelet count.
There were 26 patients with thrombocytosis and 178 patients with persistently normal platelet counts. The overall and cancer specific death rate in the 26 patients with thrombocytosis was 50% and 42%, respectively. The overall mean time between nephrectomy and death was 12.1 months in this group. The overall and cancer specific death rate in the 178 patients with a normal platelet count was 15.2% and 7.3%, respectively. Mean time to death was 22.6 months in this group. Differences in the overall and cancer specific death rates were highly statistically significant as well as clinically significant. These differences remained significant after controlling for grade, stage and histological type of cancer.
This study documents the association of thrombocytosis with decreased survival in patients with renal cell carcinoma. In those who undergo nephrectomy for early stage renal cell carcinoma with a perioperative platelet count of greater than 400,000/mm. the cancer specific death rate from renal cell carcinoma is greater than 5 times the rate in patients with a persistently normal platelet counts after radical nephrectomy. The platelet count appears to be a new and powerful independent prognosticator in patients with renal cell carcinoma who undergo radical nephrectomy for presumed localized disease.
我们之前报道过，晚期肾细胞癌且血小板计数正常（400,000/mm³）的患者与血小板增多症患者相比，预期寿命增加了64%。我们确定在对早期疾病进行根治性肾切除术后，血小板增多症是否可预测肾细胞癌导致的死亡。
我们回顾了1993年6月至2000年1月在埃默里大学医院接受根治性肾切除术且有治愈意图的204例肾细胞癌患者的记录。生存情况、病理分级和分期从埃默里温希普癌症研究所肿瘤登记处获取。记录血小板计数，任何至少有一次血小板计数大于400,000/mm³的患者被归类为血小板增多症。血小板计数为400,000/mm³的患者被归类为血小板计数正常。
有26例血小板增多症患者和178例血小板计数持续正常的患者。26例血小板增多症患者的总死亡率和癌症特异性死亡率分别为50%和42%。该组肾切除术后至死亡的总体平均时间为12.1个月。178例血小板计数正常的患者的总死亡率和癌症特异性死亡率分别为15.2%和7.3%。该组的平均死亡时间为22.6个月。总死亡率和癌症特异性死亡率的差异在统计学上具有高度显著性，在临床上也具有显著性。在控制癌症的分级、分期和组织学类型后，这些差异仍然显著。
本研究证明了血小板增多症与肾细胞癌患者生存率降低之间的关联。在因早期肾细胞癌接受肾切除术且围手术期血小板计数大于400,000/mm³的患者中，肾细胞癌导致的癌症特异性死亡率比根治性肾切除术后血小板计数持续正常的患者高出5倍以上。血小板计数似乎是接受根治性肾切除术治疗疑似局限性疾病的肾细胞癌患者一个新的强有力的独立预后指标。
