title: Impact of preoperative thrombocytosis on pathological outcomes and survival in patients treated with radical cystectomy for bladder carcinoma.
abstract: OBJECTIVE
  To investigate the impact of preoperative platelet count on pathological findings at the time of Radical Cystectomy for Bladder Cancer and postoperative cancer-specific and overall survival.
  
  
  METHODS
  A total of 906 consecutive patients treated with Radical Cystectomy for Bladder Cancer between 1995 and 2012 at a tertiary referral Center were included in the study. Thrombocytosis was defined as >400,000 platelets/μl, in agreement with the standard assumed by the central laboratory of our Institution. Univariable and multivariable logistic regression analyses were used to investigate the impact of preoperative platelet count on pathological stage. Univariate and multivariate Cox regression analyses were also adopted to predict both cancer-specific and overall survival.
  
  
  RESULTS
  The mean age at cystectomy was 67.25 years. The mean and median platelet counts were 242,100/μl and 227,500/μl. At a mean follow-up time of 41 months, the 2- and 5-year cancer-specific and overall survival were found to be 83.1% and 75.2% and 68.3 and 59.8%, respectively. At Univariable analysis, thrombocytosis count was significantly associated with adverse pathological disease stage (p ≤ 0.007) and lymph node invasion (p=0.05). Platelet count was significantly associated to patient survival at univariable analysis (Hazard Ratio=1.76 and 1.39 for overall survival and cancer specific survival, respectively; all p<0.05). At multivariate Cox regression analysis, platelet count was documented to be significantly related only to overall survival (Hazard Ratio=64,1.03-2.81; p=0.05).
  
  
  CONCLUSIONS
  Preoperative platelet count should be taken into account as a factor predictive of postoperative oncological outcomes after radical cystectomy for bladder cancer and patients should be counseled accordingly.
authors.affiliation: Department of Urology, San Raffaele Scientific institute, Urological Research Institute, Milan, Italy marco.moschini87@gmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Moschini
authors.affiliation: Department of Urology, San Raffaele Scientific institute, Urological Research Institute, Milan, Italy.
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.affiliation: Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS Santa Maria Nuova Reggio Emilia, Reggio Emilia, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Pellucchi
authors.affiliation: Department of Urology, San Raffaele Scientific institute, Urological Research Institute, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rocchini
authors.affiliation: Department of Urology, San Raffaele Scientific institute, Urological Research Institute, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: La Croce
authors.affiliation: Department of Urology, San Raffaele Scientific institute, Urological Research Institute, Milan, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.affiliation: Department of Urology, San Raffaele Scientific institute, Urological Research Institute, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Department of Urology, Magna Graecia University of Catanzaro, Doctorate Research Programm, Catanzaro, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Damiano
authors.affiliation: Department of Urology, San Raffaele Scientific institute, Urological Research Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Department of Urology, San Raffaele Scientific institute, Urological Research Institute, Milan, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Colombo
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015653:Cystectomy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010976:Platelet Count; D011300:Preoperative Care; D011379:Prognosis; D015996:Survival Rate; D013922:Thrombocytosis / Q000401:mortality*; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery
keywords: Platelets; bladder cancer; cancer-specific mortality; radical cystectomy; thrombocytosis