Thrombocytosis is Associated With a Significant Increase in the Cancer Specific Death Rate After Radical Nephrectomy

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Oct 2002Thrombocytosis is Associated With a Significant Increase in the Cancer Specific Death Rate After Radical Nephrectomy S. Casey O'keefe, Fray F. Marshall, Muta M. Issa, Mary P. Harmon, and John A. Petros S. Casey O'keefeS. Casey O'keefe , Fray F. MarshallFray F. Marshall , Muta M. IssaMuta M. Issa , Mary P. HarmonMary P. Harmon , and John A. PetrosJohn A. Petros View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64453-9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We have previously reported that patients with advanced renal cell carcinoma and a normal platelet count of 400,000/mm.3 have a 64% increase in life expectancy compared with those with thrombocytosis. We determined whether thrombocytosis was predictive of death from renal cell carcinoma after radical nephrectomy was performed with curative intent for early stage disease. Materials and Methods: We reviewed the records of 204 patients with renal cell carcinoma who underwent radical nephrectomy with curative intent between June 1993 and January 2000 at Emory University Hospital. Survival, pathological grade and stage were recorded from the Emory Winship Cancer Institute tumor registry. Platelet counts were recorded and any patient with at least 1 platelet count of greater than 400,000/mm.3 was classified with thrombocytosis. Those with a platelet count of 400,000/mm.3 were classified with a normal platelet count. Results: There were 26 patients with thrombocytosis and 178 patients with persistently normal platelet counts. The overall and cancer specific death rate in the 26 patients with thrombocytosis was 50% and 42%, respectively. The overall mean time between nephrectomy and death was 12.1 months in this group. The overall and cancer specific death rate in the 178 patients with a normal platelet count was 15.2% and 7.3%, respectively. Mean time to death was 22.6 months in this group. Differences in the overall and cancer specific death rates were highly statistically significant as well as clinically significant. These differences remained significant after controlling for grade, stage and histological type of cancer. Conclusions: This study documents the association of thrombocytosis with decreased survival in patients with renal cell carcinoma. In those who undergo nephrectomy for early stage renal cell carcinoma with a perioperative platelet count of greater than 400,000/mm.3 the cancer specific death rate from renal cell carcinoma is greater than 5 times the rate in patients with a persistently normal platelet counts after radical nephrectomy. The platelet count appears to be a new and powerful independent prognosticator in patients with renal cell carcinoma who undergo radical nephrectomy for presumed localized disease. References 1 : Prognostic factors in renal cancer. Urol Clin North Am1993; 20: 247. Google Scholar 2 : Thrombocytosis associated with malignant disease. Arch Intern Med1964; 114: 497. Google Scholar 3 : Poor prognosis associated with thrombocytosis in patients with renal cell carcinoma. BJU Int2000; 86: 203. Google Scholar 4 : Common Statistical Methods for Clinical Research. Cary, North Carolina: SAS Institute1997. Google Scholar 5 : Elevated serum interleukin-6 levels in patients with reactive thrombocytosis. Br J Haematol1991; 79: 286. Google Scholar 6 : Role of interleukin-6 in paraneoplastic thrombocytosis. Blood1993; 82: 2261. Google Scholar 7 : A phase I trial of intravenous interleukin-6 in patients with advanced cancer. J Immunother Emphasis Tumor Immunol1994; 15: 292. Google Scholar 8 : Interleukin-6 and renal cell cancer: production, regulation, and growth effects. Cancer Immunol Immunother1992; 35: 97. Google Scholar 9 : Enhanced expression of interleukin-6 in primary human renal cell carcinomas. J Natl Cancer Inst1991; 83: 1668. Google Scholar 10 : Serum interleukin-6 levels in metastatic renal cell carcinoma before treatment with interleukin-2 correlates with paraneoplastic syndromes but not patient survival. J Urol1998; 159: 718. Link, Google Scholar 11 : Immunomodulatory and hematopoietic effects of recombinant human interleukin-6 in patients with advanced renal cell cancer. J Interferon Cytokine Res1996; 16: 903. Google Scholar 12 : Lack of efficacy of recombinant human interleukin-6 in patients with advanced renal cell cancer: results of a phase II study. Eur J Cancer1998; 34: 754. Google Scholar 13 : Role of platelets in tumor cell metastases. Ann Intern Med1981; 95: 636. Google Scholar 14 : Thrombospondin, a potentiator of tumor cell metastasis. Cancer Res1987; 47: 4130. Google Scholar 15 : Addition of both platelets and thrombin in combination accelerates tumor cells to adhere to endothelial cells in vitro. In Vitro Cell Dev Biol Anim1997; 33: 182. Google Scholar 16 : Platelet-derived growth factor. Structure, function and implications in normal and malignant cell growth. Acta Oncol1993; 32: 101. Google Scholar 17 : Structural and functional aspects of platelet-derived growth factor. Br J Cancer1988; 57: 591. Google Scholar 18 : Functional intactness of stimulatory and inhibitory autocrine loops in human renal carcinoma cell lines of the clear cell type. J Urol1997; 157: 2345. Link, Google Scholar 19 : Markedly increased amounts of messenger RNAs for vascular endothelial growth factor and placenta growth factor in renal cell carcinoma associated with angiogenesis. Cancer Res1994; 54: 4233. Google Scholar 20 : Negative regulation of hypoxia-induced genes by the von Hippel-Lindau protein. Proc Natl Acad Sci USA1996; 93: 10595. Google Scholar From the Department of Urology, Emory University School of Medicine, Emory Winship Cancer Institute and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byLaguna M (2020) Re: Chest Computed Tomography for Staging Renal Tumours: Validation and Simplification of a Risk Prediction Model from a Large Contemporary Retrospective CohortJournal of Urology, VOL. 204, NO. 5, (1093-1094), Online publication date: 1-Nov-2020.Johnson T, Abbasi A, Owen-Smith A, Young A, Ogan K, Pattaras J, Nieh P, Marshall F and Master V (2009) Absolute Preoperative C-Reactive Protein Predicts Metastasis and Mortality in the First Year Following Potentially Curative Nephrectomy for Clear Cell Renal Cell CarcinomaJournal of Urology, VOL. 183, NO. 2, (480-485), Online publication date: 1-Feb-2010.Marshall F (2007) Urological Oncology: Renal, Ureteral and Retroperitoneal TumorsJournal of Urology, VOL. 178, NO. 3, (819-821), Online publication date: 1-Sep-2007.Bensalah K, Leray E, Fergelot P, Rioux-Leclercq N, Tostain J, Guillé F and Patard J (2018) Prognostic Value of Thrombocytosis in Renal Cell CarcinomaJournal of Urology, VOL. 175, NO. 3, (859-863), Online publication date: 1-Mar-2006.Marshall F (2018) Significance of Thrombocytosis for Determining Prognosis in Patients With Localized Renal Cell CarcinomaJournal of Urology, VOL. 173, NO. 2, (410-410), Online publication date: 1-Feb-2005. Volume 168Issue 4 Part 1October 2002Page: 1378-1380 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsmortalitykidneynephrectomythrombocytosiscarcinoma, renal cellMetricsAuthor Information S. Casey O'keefe More articles by this author Fray F. Marshall More articles by this author Muta M. Issa More articles by this author Mary P. Harmon More articles by this author John A. Petros More articles by this author Expand All Advertisement PDF downloadLoading ...