Small platelet volume predicts recurrence, death in patients with renal cell carcinoma
In patients with renal cell carcinoma, mean platelet volume is a highly significant risk factor for recurrence and cancer-specific death, a recent study has found. This parameter enhances the accuracy of the Leibovich prognosis score to better predict long-term outcomes in localized renal cell carcinoma cases following curative surgical resection.
Records of 652 patients were retrospectively analysed to assess the potential prognostic value of mean platelet volume and its ability to improve existing risk assessment tools used in adjuvant clinical trials in nonmetastatic renal cell carcinoma cases.
Researchers evaluated the associations between mean platelet volume and baseline covariates and clinical outcomes (recurrence and death from renal cell carcinoma and other causes) with the competing risk estimators of Kaplan-Meier, and Marubini and Valsecchi, respectively. They also generated univariable and multivariable Cox proportional hazard models. The Harrell c-index was used to test improvements in the predictive accuracy of the established Leibovich prognosis score.
Small platelet volume correlated with large tumours (p=0.043), high Fuhrman grade (p=0.001), sarcomatoid components (p<0.0001), histological tumour necrosis (p=0.044) and vascular invasion (p=0.022). Univariable and multivariable analyses showed that small platelet volume was a strong predictor of recurrent renal cell carcinoma (continuously and binary coded) and cancer-specific survival.
Adding mean platelet volume improved the discriminative performance of the Leibovich prognosis score (c-index, 0.83; p=0.004).
In addition, a study by Pichler and colleagues found that adding vascular invasion improved the predictive accuracy of their validation data by 1.4 percent over that of the Leibovich prognosis score. Patients with a score of ≥7 had a >85-percent chance of metastatic disease at 10 years, indicating that they could be considered candidates for adjuvant treatment trials. [J Urol 2012;187:834-9]