Peking University Health Science Centre, 100191, Beijing, People's Republic of China.
Department of Urology, Peking University Third Hospital, No.49 North Garden Road, Haidian District, 100191, Beijing, People's Republic of China.
BMC Urol. 2021 Feb 27;21(1):31. doi: 10.1186/s12894-021-00796-6.
BACKGROUND : This study aimed to determine the prognostic value of preoperative blood parameters in renal cell carcinoma (RCC) and tumour thrombus (TT) patients that were surgically treated.
We retrospectively analysed clinicopathological data and blood parameters of 146 RCC and TT patients that were surgically treated. Univariate or multivariate Cox regression analyses were performed to determine the risk factors associated with progression-free survival (PFS) and overall survival (OS). Kaplan-Meier analysis and logistic regression were performed to study the risk factors. Receiver operating characteristic curves were applied to test improvements in the predictive accuracy of the established prognosis score.
On univariate and multivariate analysis, anaemia (HR 2.873, P = 0.008) and lymph node metastasis (HR 4.811, P = 0.015) were independent prognostic factors linked to OS. Besides, thrombocytosis (HR 2.324, P = 0.011), histologic subtype (HR 2.835, P = 0.004), nuclear grade (HR 2.069, P = 0.033), and lymph node metastasis (HR 5.739, P = 0.001) were independent prognostic factors associated with PFS. Kaplan-Meier curves revealed that patients with anaemia exhibited worse OS than those without it (P = 0.0033). Likewise, patients with thrombocytosis showed worse PFS than those without it (P < 0.0001). Adding the anaemia and thrombocytosis to the SSIGN score improved its predictive accuracy related to OS and PFS. Preoperative anaemia was linked to more symptom at presentation (OR 3.348, P = 0.006), longer surgical time (OR 1.005, P = 0.001), more blood loss (OR 1.000, P = 0.018), more transfusion (OR 2.734, P = 0.004), higher thrombus level (OR 4.750, P = 0.004) and higher nuclear grade (OR 3.449, P = 0.001) while thrombocytosis was associated with more symptom at presentation (OR 7.784, P = 0.007).
Preoperative anaemia and thrombocytosis were adverse prognostic factors in non-metastatic RCC patients with TT. Also, both preoperative anaemia and thrombocytosis can be clinically used for risk stratification of non-metastatic RCC and TT patients.
本研究旨在确定接受手术治疗的肾细胞癌（RCC）和肿瘤血栓（TT）患者术前血液参数的预后价值。
我们回顾性分析了 146 例接受手术治疗的 RCC 和 TT 患者的临床病理数据和血液参数。使用单因素或多因素 Cox 回归分析确定与无进展生存期（PFS）和总生存期（OS）相关的风险因素。Kaplan-Meier 分析和 logistic 回归用于研究风险因素。接受者操作特征曲线用于检验建立的预后评分的预测准确性的提高。
单因素和多因素分析显示，贫血（HR 2.873，P=0.008）和淋巴结转移（HR 4.811，P=0.015）是与 OS 相关的独立预后因素。此外，血小板增多症（HR 2.324，P=0.011）、组织学亚型（HR 2.835，P=0.004）、核分级（HR 2.069，P=0.033）和淋巴结转移（HR 5.739，P=0.001）是与 PFS 相关的独立预后因素。Kaplan-Meier 曲线显示，贫血患者的 OS 比无贫血患者差（P=0.0033）。同样，血小板增多症患者的 PFS 比无血小板增多症患者差（P<0.0001）。将贫血和血小板增多症加入 SSIGN 评分可提高其与 OS 和 PFS 相关的预测准确性。术前贫血与更多的症状表现（OR 3.348，P=0.006）、更长的手术时间（OR 1.005，P=0.001）、更多的失血（OR 1.000，P=0.018）、更多的输血（OR 2.734，P=0.004）、更高的血栓水平（OR 4.750，P=0.004）和更高的核分级（OR 3.449，P=0.001）相关，而血小板增多症与更多的症状表现（OR 7.784，P=0.007）相关。
术前贫血和血小板增多症是非转移性 RCC 伴 TT 患者的不良预后因素。此外，术前贫血和血小板增多症均可用于非转移性 RCC 和 TT 患者的风险分层。
