The association of platelet count with clinicopathological significance and prognosis in renal cell carcinoma: a systematic review and meta-analysis

Abstract

Objective: Elevated platelet count (PC), a measure of systemic inflammatory response, is inconsistently reported to be associated with poor prognosis in patients with renal cell carcinoma (RCC). We conducted a systematic review and meta-analysis to clarify the significance of PC in RCC prognosis.

Methods: PubMed, Embase, and Web of Science databases were searched to identify eligible studies to evaluate the associations of PC with patient survival and clinicopathological features of RCC.

Results: We analyzed 25 studies including 11,458 patients in the meta-analysis and categorized the included articles into three groups based on RCC stage. An elevated PC level was associated with poor overall survival (OS, hazard ratio [HR] 2.24, 95% confidence interval [CI] 1.87-2.67, P<0.001) and cancer-specific survival (CSS, HR 2.59, 95% CI 1.92-3.48, P<0.001) when all stages were examined together; with poor CSS (HR 5.09, 95% CI 2.41-10.73, P<0.001) and recurrence-free survival (HR 6.68, 95% CI 3.35-13.34, P<0.001) for localized RCC; with poor OS (HR 2.00, 95% CI 1.75-2.28, P<0.001) for metastatic RCC; and with poor OS (HR 2.05, 95% CI 1.04-4.03, P = 0.038), CSS (HR 3.38, 95% CI 1.86-6.15, P<0.001), and PFS (HR 2.97, 95% CI 1.47-6.00, P = 0.002) for clear cell RCC. Furthermore, an elevated PC level was significantly associated with TNM stage (OR 3.11, 95% CI 1.59-6.06, P = 0.001), pathological T stage (OR 3.13, 95% CI 2.60-3.77, P<0.001), lymph node metastasis (OR 4.01, 95% CI 2.99-5.37, P<0.001), distant metastasis (OR 3.85, 95% CI 2.46-6.04, P<0.001), Fuhrman grade (OR 3.70, 95% CI 3.00-4.56, P<0.001), tumor size (OR 4.69, 95% CI 2.78-7.91, P<0.001) and Eastern Cooperative Oncology Group score (OR 5.50, 95% CI 3.26-9.28, P<0.001).

Conclusion: An elevated PC level implied poor prognosis in patients with RCC and could serve as a readily available biomarker for managing this disease.

Fig 1. Flowchart of selecting studies for inclusion in this meta-analysis.

Fig 2. Forest plots of studies evaluating hazard ratios of elevated PC level compared with normal level.

(A) Elevated PC level was associated with shorter overall survival and cancer-specific survival in renal cell carcinoma (All-stage group); (B) Elevated PC level was associated with poorer cancer-specific survival and recurrence-free survival in localized RCC (Localized group); (C) For metastatic RCC, elevated PC level was associated with worse overall survival but not progression-free survival (metastatic group); (D) For clear cell RCC, elevated PC level was associated with poorer overall survival, cancer-specific survival and progression-free survival.

Fig 3. Funnel plots, Begg and Egger tests result for the evaluation of potential publication bias.

Plots are arranged as follows: (A) RCC CSS; (B) MRCC OS; (C) PC pT stage; (D) PC Fuhrman grade.