Foerster Beat, Moschini Marco, Abufaraj Mohammad, Soria Francesco, Gust Kilian M, Rouprêt Morgan, Karakiewicz Pierre I, Briganti Alberto, Rink Michael, Kluth Luis, Mathieu Romain, Margulis Vitaly, Lotan Yair, Aziz Atiqullah, John Hubert, Shariat Shahrokh F
Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland.
Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
Clin Genitourin Cancer. 2017 Dec;15(6):e1039-e1045. doi: 10.1016/j.clgc.2017.06.003. Epub 2017 Jun 19.
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.
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 × 10/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.
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.
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.
本研究旨在评估在一个大型多机构患者队列中，术前血小板增多症（TC）在根治性肾输尿管切除术（RNU）治疗上尿路尿路上皮癌（UTUC）后的预测和预后作用。
回顾性分析了1990年至2008年间2492例因非转移性UTUC接受RNU治疗患者的记录。术前TC定义为血小板计数>400×10⁹/L，不考虑性别类型。进行逻辑回归分析以评估其与病理特征的关联。采用Cox比例风险回归来估计无复发生存率、癌症特异性生存率和总生存率。
309例（12.4%）患者存在术前TC，且与肿瘤晚期、高级别、淋巴结转移、淋巴管浸润、肿瘤结构、坏死及伴发原位癌相关（P值≤0.027）。在调整了年龄、性别、部位、多灶性和肿瘤结构影响的术前模型中，术前TC独立预测≥pT2（P<0.001）、非器官局限性（P<0.001）和淋巴结阳性（P<0.001）疾病。在中位随访45个月期间，663例（26.6%）患者出现复发，545例（21.9%）死于UTUC。在单变量Cox比例风险回归分析中，TC与无复发生存率（风险比[HR]，1.32；P=0.015）和总生存率（HR，1.4；P<0.001）显著相关，但与癌症特异性生存率无关（HR，1.17；P=0.2）。在术前和术后多变量模型中，当调整了标准临床病理特征的影响后，TC与生存结局不再相关。
术前TC与不良临床病理特征相关，并预测RNU时病理情况较差。在其他血清生物标志物中，TC有助于术前风险分层并指导治疗决策。
