A new prognostic model for cancer-specific survival after radical cystectomy including pretreatment thrombocytosis and standard pathological risk factors

作者：Todenhoefer Tilman; Renninger Markus; Schwentner Christian; Stenzl Arnulf; Gakis Georgios^*

来源：BJU International, 2012, 110(11B): E533-E540.

DOI：10.1111/j.1464-410X.2012.11231.x

• thrombocytosis
• platelets
• bladder cancer
• risk factor
• radical cystectomy

OBJECTIVE %26lt;br%26gt;To investigate the oncological significance of preoperative thrombocytosis in patients with invasive bladder cancer undergoing radical cystectomy, as it has been reported as a marker for aggressive tumour biology in a variety of solid tumours. %26lt;br%26gt;PATIENTS AND METHODS %26lt;br%26gt;The series comprised 258 patients undergoing radical cystectomy between 1999 and 2010 in whom different clinical and histopathological parameters were assessed. %26lt;br%26gt;Elevated platelet count was defined as %26gt;450 x 10(9)/L. %26lt;br%26gt;Based on regression estimates of significant parameters in multivariable analysis a new weighted scoring model was developed to predict cancer-specific outcomes. %26lt;br%26gt;RESULTS %26lt;br%26gt;The median follow-up was 30 months (6-116). %26lt;br%26gt;Of the 258 patients, 26 (10.1%) had elevated and 232 (89.9%) had normal platelet count. The 3-year cancer-specific survival in patients with normal and elevated platelet count was 61.5% and 32.7%, respectively (P %26lt; 0.001). %26lt;br%26gt;In multivariable analysis, cancer-specific survival was significantly lower in patients with locally advanced disease (%26gt;= pT3a) (relative risk 2.91, 1.54-5.65; P = 0.001), positive soft tissue surgical margins (4.03, 1.99-7.92; P = 0.001) and thrombocytosis (2.68, 1.26-5.14; P = 0.011). %26lt;br%26gt;The 3-year cancer-specific survival in patients with a score 0 (low risk), 1-2 (intermediate risk) and 3-5 (high risk) was 81.0%, 54.8% and 8.2%, respectively (P %26lt; 0.001). %26lt;br%26gt;Consideration of preoperative platelet count in the final model increased its predictive accuracy by 1.8% with a concordance index of 0.745 (P = 0.040). %26lt;br%26gt;CONCLUSIONS %26lt;br%26gt;The presence of thrombocytosis at radical cystectomy portends unfavourable prognosis. %26lt;br%26gt;We constructed a simple weighted prognostic model for cancer-specific outcomes after radical cystectomy based on pretreatment platelet count and established pathological risk factors. %26lt;br%26gt;These data warrant external validation and may allow for tailored monitoring and selection of appropriate patients for neoadjuvant and adjuvant trials.

• 出版日期2012-12