Presented by: PHIL HYUN SONG MD.PhD.
Department of Urology, College of Medicine, Yeungnam University

Introduction

In urothelial carcinoma (UC) of the bladder, preoperative thrombocytosis (PTC) has been identified as a predictor for oncologic outcome and survival after radical cystectomy. The aim of this study was to investigate the influence of an elevated platelet count in patients undergoing radical nephroureterectomy with bladder cuff excision (NUx) for UC from renal calyx to distal ureter on the oncological prognosis. Furthermore, the correlations of PTC with pathological parameters and perioperative blood transfusion (PBT) rates were analyzed.

Materials

A retrospective analysis of 110 patients undergoing NUx for UC between 2005 and 2022 was performed. For the cohort PTC was defined as a platelet count > 450 G/. Chi-square test was used to analyze the association of PTC with categorical variables including tumor stage, grade and PBT parameters. Cox regression analyses were used to investigate the association of PTC with outcome.

Results

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The median age of patients at the moment of each operation was 69 years, 20.8% were female and 73.2% were male. The median PPC in the cohort was 272 G/l. PTC was detected in 29.67% of the patients. The median follow-up was 49 months. The cancer specific survival adapted to PTC (thrombocytes:< 450 G/l vs. > 450 G/l) was 98.4% vs. 92.5% after 1 years and 92.1% vs. 12.2% after 5 years, respectively. PTC was significantly associated with muscle invasion, periureteral fat invasion and lymphovascular invasion (p<0.001). PTC was also significantly associated with a higher rate of PBT (62.94% vs. 58.83%; p<0.001). In the multivariate analysis PTC was significantly related to poor oncological survival (Hazard Ratio=6.052; p=0.008).

Conclusion

In this study, PTC was significantly associated with impaired oncological outcomes of patients undergoing NUx for UC. It represents an independent prognostic factor in oncological outcomes after NUx. PTC is also significantly correlated to an increased rate of PBT, which can be explained through tumor associated alterations of hemostasis.

Funding

None

Co-Authors

Jae Young Choi,
Department of Urology, College of Medicine, Yeungnam University

Tae-Hwan Kim, MD. PhD
Department of Urology, School of Medicine, Kyungpook National University

Kyung-jin Oh, MD.PhD
Chonnam National University Hospital