title: Prognostic relevance of postoperative platelet count in upper tract urothelial carcinoma after radical nephroureterectomy.
abstract: OBJECTIVE
  To assess the impact of perioperative platelet count (PLT) kinetics on recurrence-free survival (RFS) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).
  
  
  METHODS
  From three prospectively maintained databases of three tertiary care centres a total of 269 patients undergoing RNU without perioperative treatment between 1996 and 2011 were considered for this analysis. Pre- and postoperatively elevated PLT count was defined as >400×10(9)/L. PLT levels were measured 1-3 days preoperatively and 7-10 days postoperatively. The median follow-up was 24 months (Interquartile range (IQR): 10-52). A new weighted scoring model was developed to predict recurrence after RNU based on significant parameters of multivariable analysis.
  
  
  RESULTS
  The 5-year RFS in patients with preoperatively normal and elevated PLT count was 58.3% and 29.3%, respectively (p<0.001). The 5-year-RFS was 57.6% in patients with normal postoperative PLT count and 29.7% in those with elevated PLT levels (p<0.001). In multivariable analysis, pT-stage, lymphovascular invasion, ureteral margin status and postoperative thrombocytosis remained independent predictors for RFS. The 5-year RFS in patients with a score of 0 (low-risk), 1 (intermediate-risk) and 2-4 (high-risk) was 77.7%, 47.5% and 12.3%, respectively (p<0.001). Consideration of the variable postoperative thrombocytosis in the final model increased its predictive accuracy by 1.9% with a concordance index of 0.758 (p=0.015).
  
  
  CONCLUSIONS
  PLT kinetics is significantly associated with RFS after RNU for UTUC. We constructed a simple, PLT-based prognostic model for recurrence after RNU.
authors.affiliation: Department of Urology, University Hospital Tübingen, Tübingen, Germany. Electronic address: georgios.gakis@googlemail.com.
authors.forename: Georgios
authors.initials: G
authors.lastname: Gakis
authors.affiliation: Department of Urology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.affiliation: Department of Urology, University Hospital Tübingen, Tübingen, Germany.
authors.forename: Fahmy
authors.initials: F
authors.lastname: Hassan
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Luis
authors.initials: L
authors.lastname: Kluth
authors.affiliation: Department of Urology, University Hospital Tübingen, Tübingen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Miller
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Soave
authors.affiliation: Department of Urology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Otto
authors.affiliation: Department of Urology, University Hospital Tübingen, Tübingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schwentner
authors.affiliation: Department of Urology, University Hospital Tübingen, Tübingen, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Todenhöfer
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Dahlem
authors.affiliation: Department of Urology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Maximillian
authors.initials: M
authors.lastname: Burger
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.affiliation: Department of Urology, University Hospital Tübingen, Tübingen, Germany.
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.affiliation: Department of Urology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Atiqullah
authors.initials: A
authors.lastname: Aziz
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Rink
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000097:blood / Q000601:surgery*; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010976:Platelet Count; D011184:Postoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014513:Ureter / Q000601:surgery*; D014551:Urinary Tract / Q000473:pathology*; D014571:Urologic Neoplasms / Q000097:blood / Q000601:surgery*
keywords: Outcome; Platelet; Radical nephroureterectomy; Recurrence-free survival; Thrombocytosis; Upper tract urothelial carcinoma