Prognostic relevance of postoperative platelet count in upper tract urothelial carcinoma after radical nephroureterectomy
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Prognostic relevance of postoperative platelet count in upper tract urothelial carcinoma after radical nephroureterectomy. / Gakis, Georgios; Fritsche, Hans-Martin; Hassan, Fahmy; Kluth, Luis; Miller, Florian; Soave, Armin; Otto, Wolfgang; Schwentner, Christian; Todenhöfer, Tilman; Dahlem, Roland; Burger, Maximillian; Fisch, Margit; Stenzl, Arnulf; Aziz, Atiqullah; Rink, Michael.
in: EUR J CANCER, Jahrgang 50, Nr. 15, 01.10.2014, S. 2583-2591.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Prognostic relevance of postoperative platelet count in upper tract urothelial carcinoma after radical nephroureterectomy
AU - Gakis, Georgios
AU - Fritsche, Hans-Martin
AU - Hassan, Fahmy
AU - Kluth, Luis
AU - Miller, Florian
AU - Soave, Armin
AU - Otto, Wolfgang
AU - Schwentner, Christian
AU - Todenhöfer, Tilman
AU - Dahlem, Roland
AU - Burger, Maximillian
AU - Fisch, Margit
AU - Stenzl, Arnulf
AU - Aziz, Atiqullah
AU - Rink, Michael
N1 - Copyright © 2014 Elsevier Ltd. All rights reserved.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - AIM OF THE STUDY: To assess the impact of perioperative platelet count (PLT) kinetics on recurrence-free survival (RFS) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).METHODS: From three prospectively maintained databases of three tertiary care centres a total of 269 patients undergoing RNU without perioperative treatment between 1996 and 2011 were considered for this analysis. Pre- and postoperatively elevated PLT count was defined as >400×10(9)/L. PLT levels were measured 1-3 days preoperatively and 7-10 days postoperatively. The median follow-up was 24 months (Interquartile range (IQR): 10-52). A new weighted scoring model was developed to predict recurrence after RNU based on significant parameters of multivariable analysis.RESULTS: The 5-year RFS in patients with preoperatively normal and elevated PLT count was 58.3% and 29.3%, respectively (p<0.001). The 5-year-RFS was 57.6% in patients with normal postoperative PLT count and 29.7% in those with elevated PLT levels (p<0.001). In multivariable analysis, pT-stage, lymphovascular invasion, ureteral margin status and postoperative thrombocytosis remained independent predictors for RFS. The 5-year RFS in patients with a score of 0 (low-risk), 1 (intermediate-risk) and 2-4 (high-risk) was 77.7%, 47.5% and 12.3%, respectively (p<0.001). Consideration of the variable postoperative thrombocytosis in the final model increased its predictive accuracy by 1.9% with a concordance index of 0.758 (p=0.015).CONCLUSION: PLT kinetics is significantly associated with RFS after RNU for UTUC. We constructed a simple, PLT-based prognostic model for recurrence after RNU.
AB - AIM OF THE STUDY: To assess the impact of perioperative platelet count (PLT) kinetics on recurrence-free survival (RFS) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).METHODS: From three prospectively maintained databases of three tertiary care centres a total of 269 patients undergoing RNU without perioperative treatment between 1996 and 2011 were considered for this analysis. Pre- and postoperatively elevated PLT count was defined as >400×10(9)/L. PLT levels were measured 1-3 days preoperatively and 7-10 days postoperatively. The median follow-up was 24 months (Interquartile range (IQR): 10-52). A new weighted scoring model was developed to predict recurrence after RNU based on significant parameters of multivariable analysis.RESULTS: The 5-year RFS in patients with preoperatively normal and elevated PLT count was 58.3% and 29.3%, respectively (p<0.001). The 5-year-RFS was 57.6% in patients with normal postoperative PLT count and 29.7% in those with elevated PLT levels (p<0.001). In multivariable analysis, pT-stage, lymphovascular invasion, ureteral margin status and postoperative thrombocytosis remained independent predictors for RFS. The 5-year RFS in patients with a score of 0 (low-risk), 1 (intermediate-risk) and 2-4 (high-risk) was 77.7%, 47.5% and 12.3%, respectively (p<0.001). Consideration of the variable postoperative thrombocytosis in the final model increased its predictive accuracy by 1.9% with a concordance index of 0.758 (p=0.015).CONCLUSION: PLT kinetics is significantly associated with RFS after RNU for UTUC. We constructed a simple, PLT-based prognostic model for recurrence after RNU.
KW - Aged
KW - Carcinoma, Transitional Cell
KW - Databases, Factual
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Nephrectomy
KW - Outcome Assessment (Health Care)
KW - Platelet Count
KW - Postoperative Period
KW - Prognosis
KW - Proportional Hazards Models
KW - Tertiary Care Centers
KW - Ureter
KW - Urinary Tract
KW - Urologic Neoplasms
U2 - 10.1016/j.ejca.2014.07.003
DO - 10.1016/j.ejca.2014.07.003
M3 - SCORING: Journal article
C2 - 25088206
VL - 50
SP - 2583
EP - 2591
JO - EUR J CANCER
JF - EUR J CANCER
SN - 0959-8049
IS - 15
ER -