This study examined the 152 patients with RCC and TT treated surgically from a high volume center and found patients with preoperative anemia had significantly adverse OS than that without anemia. Besides, patients with thrombocytosis was associated with worse PFS than those without thrombocytosis. In multivariable analysis, we found preoperative anemia and thrombocytosis was an independent worse prognostic factor even adjusting for other known pathologic prognostic factors. To our knowledge, this is the first study of the preoperative blood parameters specifically focused on the population of RCC and TT.
In the previous study, anemia could be used as a prognostic factors in RCC. Kim SH et al retrospectively analyzed 4,260 patients with non-metastatic RCC and found factors include anemia were associated with worse recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS)[16]. Jiwei Huang et al analyzed 352 patients with papillary RCC and found patients with preoperative anemia had significantly worse RFS, CSS, and OS than patients without anemia (P < 0.001). Multivariable analysis revealed that anemia was an independent prognostic factor in terms of RFS, CSS, and OS (P < 0.001)[17]. Xia L et al conducted a meta-analysis and found preoperative anemia was associated with increased all-cause mortality, cancer-specific mortality, and disease recurrence[18]. Combine with previous study, our study found preoperative anemia was an independent predictor of worse OS compared to those without anemia in RCC with TT populations. We suspected reason may as follows: ①Anemia was strongly related to more aggressive cancer biology and worse pathologic characteristics. Combined with our study, patients with preoperative anemia had higher TT level and higher nuclear grade, which may cause a worse prognosis. ②As is shown in our study, preoperative anemia had higher rate of blood transfusion during operation. Some research have already confirmed transfusion had a worse impact on RCC patients after surgery[19]. ③patients with anemia preoperatively may suffered from chronic blood loss, which can cause a worse nutrition status. Despite we need further study to verify our hypothesis, anemia was not a negligible prognostic factor associated with worse survival.
Thrombocytosis had been found as a worse prognostic predictor in different kind of cancer, include nasopharyngeal carcinoma[20], gynecologic malignancies[21], melanoma[22] and colorectal cancer[23].In RCC, thrombocytosis also could be regard as a prognostic indicator. Several study had already shown patients with preoperative thrombocytosis had a worse survival than those who without[24–26].Although none of these study had confirmed the thrombocytosis had worse prognosis in population of RCC with TT, previous study had found that bland thrombus in RCC with TT was associated with adverse survival[27]. Combine with our study, patients with thrombocytosis had an increased recurrence or metastasis risk than those who without. Besides, our study had confirmed that thrombocytosis is an independent prognostic factor predicting PFS. Interestedly, previously we thought the function of platelets were mainly in limiting blood loss and promoting wound healing. Recently, preclinical and clinical studies showed that platelets can promote tumorigenesis and metastasis through a wide variety of crosstalk between platelets and cancer cells[28]. This may explain why preoperative thrombocytosis had high risk of recurrence or metastasis after surgery. Therefore, follow up plan should be given more closely in populations with RCC and TT when we found thrombocytosis preoperatively.
Although some researcher found NLR, PLR and AST/ALT and Alb level could be used as prognostic factors in RCC [8–12], in population of RCC with TT we could not found any statistically significant difference. Firstly, we supposed in patients of RCC with TT, the inflammatory status could be more complex, thus these kinds of blood marker may not suitable for specific kind of populations. Secondly, the number of patients included in the study may not sufficient to obtain statistical differences. Owing to the rarity of these population, multi-institutional study should be conducted to further investigate the prognostic value of blood parameter in this certain kind of population.
This retrospective study has several limitations. Firstly, our research is single-institutional retrospective review, which inherently include missing data and confounding bias that we could not control. Secondly, we did not collect the information about concomitant drugs, which may have an influencing on blood counts (e.g., steroids). Despite these limitations, our study is significant because we are the only research focus on the impact of preoperative blood parameter on the patients with RCC and TT.