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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (4): 647-652. doi: 10.19723/j.issn.1671-167X.2021.04.004

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Prognostic value of preoperative platelet parameters in locally advanced renal cell carcinoma

XIAO Ruo-tao,LIU Cheng,XU Chu-xiao,HE Wei,MA Lu-lin()   

  1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
  • Received:2021-03-10 Online:2021-08-18 Published:2021-08-25
  • Contact: Lu-lin MA E-mail:malulin@bjmu.edu.cn
  • Supported by:
    National Natural Science Foundation of China(81972381)

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Abstract:

Objective: To explore the prognostic value of preoperative platelet parameters in locally advanced renal cell carcinoma for the risk stratification of such patients. Methods: Clinical data of patients with locally advanced renal cell carcinoma in the Third Hospital of Peking University from January 2015 to December 2017 were collected. The patients were divided into progression group and progression-free group according to follow-up data, and preoperative platelet parameters and clinical data between the two groups were compared. The optimal cut-off value of platelet parameters was determined by receiver operating characteristic curve (ROC) and analyzed by Kaplan-Meier survival curve. Cox proportional hazards model was used to analyze the independent risk factors of PFS. Time dependent ROC curve, net reclassification index (NRI), and integrated discrimination improvement (IDI) were used to evaluate the improvement of SSIGN model by incorporating platelet parameters. Results: Of the 215 patients, 192 (89.3%) were followed up for a median of 36 months. Sixty-four patients (29.8%) had disease progression during the follow-up, and the median PFS was 46 months. In progression group, the platelet count (PLT) was higher [(250.72 ± 88.59)×109/L vs. (227.27 ± 66.94)×109/L, P=0.042] and the platelet distribution width (PDW) was lower [(12.01 ± 2.27)% vs. (13.31 ± 2.74)%, P = 0.001] than that of progression-free groups. 285×109 /L and 12.65% as the best cut-off values of PLT and PDW, the median PFS of PLT≤285×109 /L group was significantly longer than that of PLT>285×109 /L group (53 months vs. 41 months, P=0.033), and the median PFS of PDW>12.65% group was also significantly longer than that of PDW≤12.65% group (56 months vs. 41 months, P<0.001). Multivariate analysis showed that preoperative PDW (HR=0.735, P<0.001), nuclear grade Ⅲ to Ⅳ (HR=2.425, P=0.001) and sarcomatoid differentiation (HR=3.101, P=0.008) were independent risk factors for PFS. The area under the curve of PDW combined with SSIGN model was larger than that with the original SSIGN model [0.748 (95%CI:0.662-0.833) vs. 0.678 (95%CI: 0.583-0.773), P=0.193], NRI was 0.262 (P=0.04), and IDI was 0.085 (P=0.01), indicating that the predictive ability of PDW combined with SSIGN model was improved. Conclusion: Preoperative high PLT and low PDW are associated with adverse prognosis of locally advanced renal cell carcinoma, and PDW is an independent risk factor. Therefore, preoperative PDW could serve as biomarker for risk stratification of locally advanced renal cell carcinoma.

Key words: Renal cell carcinoma, Locally advanced, Platelet, Prognosis

CLC Number: 

  • R737.11

Table 1

Clinicopathological data and univariate analysis of disease progression"

Characteristics Progression free
(n=128, 66.7%)		 Progression
(n=64, 33.3%)		 P
Age/years, $\bar{x}±s$ 59.8±12.7 58.6±8.6 0.490
Gender, n(%)
Male 87 (68) 46 (71.9) 0.622
Female 41 (32) 18 (28.1)
Symptom at presentation, n(%) 35 (27.3) 38 (59.4) <0.001*
BMI/(kg/m2), $\bar{x}±s$ 25.4±3.5 24.7±3.3 0.135
Comorbidities, n(%)
Hypertension 54 (42.2) 29 (45.3) 0.758
Diabetes mellitus 26 (20.3) 6 (9.4) 0.065
Surgical approach, n(%)
Open 50 (39.1) 29 (45.3) 0.439
Laparoscopic 78 (60.9) 35 (54.7)
Surgical time/min, $\bar{x}±s$ 193.60±94.03 276.23±130.14 <0.001
Interoperative blood loss/mL, $\bar{x}±s$ 359.53±951.83 711.72±1 063.19 0.027
Tumor side, n(%) 1.000
Left 69 (53.9) 34 (53.1)
Right 59 (46.1) 30 (46.9)
Tumor size/cm, $\bar{x}±s$ 6.6±3.7 7.1±2.8 0.345
Histologic subtype, n(%) 0.649
CCRCC 113 (88.3) 55 (85.9)
Non-CCRCC 15 (11.7) 9 (14.1)
Nuclear grade, n(%) <0.001*
Ⅰ to Ⅱ 86 (67.2) 27 (42.2)
Ⅲ to Ⅳ 32 (25) 36 (56.3)
Unknow 10 (7.8) 1 (1.6)
Necrosis, n(%) 27 (21.1) 33 (51.6) <0.001*
Sarcomatoid differentiation, n(%) 4 (3.1) 7 (10.9) 0.044*
Rheumatoid differentiation, n(%) 5 (3.9) 5 (7.8) 0.305
Lymphovascular invasion, n(%) 14 (10.9) 17 (26.6) 0.011*
Renal sinus invasion, n(%) 95 (74.2) 47 (73.4) 1.000
Perirenal fat invasion, n(%) 30 (23.4) 23 (35.9) 0.087
Urinary collecting system invasion, n(%) 3 (2.3) 5 (7.8) 0.120
Venous tumor thrombus, n(%) 37 (28.9) 38 (59.4) <0.001*
Lymph node invasion, n(%) 2 (1.6) 6 (9.4) 0.018*
Adrenal invasion, n(%) 4 (3.1) 6 (9.4) 0.086
SSIGN score, n(%) 0.013
0-3 46 (35.9) 12 (18.8)
4-6 73 (57) 41 (64.1)
7-11 9 (7) 11 (17.2)
Platelet indices
PLT/(×109/L), $\bar{x}±s$ 227.27±66.94 250.72±88.59 0.042*
MPV/fL, $\bar{x}±s$ 10.12±1.26 9.96±0.97 0.394
PDW/%, $\bar{x}±s$ 13.31±2.74 12.01±2.27 0.001*

Figure 1

Kaplan-Meier for progression-free survival curve of renal cell carcinoma patients with different level of PLT (A) and PDW (B)"

Table 2

Multivariate analysis results of Cox proportional hazards model for postoperative progression of renal cell carcinoma"

Items B SE Wald P Exp(B) (95%CI)
Nuclear grade
Ⅰ to Ⅱ Ref - - - -
Ⅲ to Ⅳ 0.886 0.275 10.343 0.001 2.425 (1.413-4.161)
Unknow -0.984 1.021 0.929 0.335 0.374 (0.051-2.764)
Sarcomatoid differentiation 1.132 0.428 6.999 0.008 3.101 (1.341-7.170)
PDW* -0.308 0.067 20.884 <0.001 0.735 (0.644-0.839)

Figure 2

The time-dependent ROC curve was used to evaluate the improvement of the SSIGN model by incorporating PDW compared to original model"

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