Predictive and Prognostic Value of Preoperative Thrombocytosis in Upper Tract Urothelial Carcinoma

Beat Foerster; Marco Moschini; Mohammad Abufaraj; Francesco Soria; Kilian M Gust; Morgan Rouprêt; Pierre I Karakiewicz; Alberto Briganti; Michael Rink; Luis Kluth; Romain Mathieu; Vitaly Margulis; Yair Lotan; Atiqullah Aziz; Hubert John; Shahrokh F Shariat; UTUC Collaboration

doi:10.1016/j.clgc.2017.06.003

Predictive and Prognostic Value of Preoperative Thrombocytosis in Upper Tract Urothelial Carcinoma

Clin Genitourin Cancer. 2017 Dec;15(6):e1039-e1045. doi: 10.1016/j.clgc.2017.06.003. Epub 2017 Jun 19.

Authors

Beat Foerster¹, Marco Moschini², Mohammad Abufaraj³, Francesco Soria⁴, Kilian M Gust⁵, Morgan Rouprêt⁶, Pierre I Karakiewicz⁷, Alberto Briganti⁸, Michael Rink⁹, Luis Kluth⁹, Romain Mathieu¹⁰, Vitaly Margulis¹¹, Yair Lotan¹¹, Atiqullah Aziz⁹, Hubert John¹², Shahrokh F Shariat¹³; UTUC Collaboration

Affiliations

¹ Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland.
² Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
³ Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.
⁴ Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy.
⁵ Department of Urology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
⁶ Department of Urology, Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris and Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France.
⁷ Department of Urology, University of Montreal, Montreal, Canada.
⁸ Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
⁹ Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁰ Department of Urology, Rennes University Hospital, Rennes, France.
¹¹ Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
¹² Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland.
¹³ Department of Urology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Weill Cornell Medical College, New York, NY. Electronic address: shahrokh.shariat@meduniwien.ac.at.

PMID: 28694147
DOI: 10.1016/j.clgc.2017.06.003

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: Cancer of urinary tract; Platelet count; Prognostic factors; Radical nephroureterectomy; Urothelium.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Carcinoma, Transitional Cell / surgery*
Disease-Free Survival
Female
Humans
Logistic Models
Lymphatic Metastasis
Male
Middle Aged
Nephroureterectomy
Preoperative Period
Prognosis
Retrospective Studies
Survival Analysis
Thrombocytosis / epidemiology*
Treatment Outcome
Urologic Neoplasms / surgery*