The Prognostic Significance of Inflammation-Associated Blood Cell Markers in Patients with Upper Tract Urothelial Carcinoma

Cheng, Yen Chen; Huang, Ching‐Wen; Wu, Wen‐Jeng; Li, Ching Chia; Ke, Hung‐Lung; Li, Wei Ming; Tu, Hung-Pin; Li, Chien‐Feng; Chang, Lin; Yeh, Hsin Chih

doi:10.1245/s10434-015-4781-z

Cited by 44 publications

(40 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After removed duplicate and irrelevant papers, a total of 16 articles were included in this analysis. For case ascertainment, fifteen articles [13–27] performed retrospective analysis (3953 participants), and one article [28] had both a retrospective design and a prospectively design in two independent patients population (314 participants). Therefore, a total of 16 articles including 17 studies with 4267 patients were included in this analysis with a median sample size of 179 (from 81 to 938).…”

Section: Resultsmentioning

confidence: 99%

Prognostic value of RDW in cancers: a systematic review and meta-analysis

et al. 2016

View full text Add to dashboard Cite

Red blood cell distribution width (RDW), a parameter that used to differentiate the type of anemia for several decades, recent studies suggest it was a prognostic factor in various types of cancer patients. However, the prognostic value of RDW in cancer patients remains controversial. Here, we performed a meta-analysis and systematic review to evaluate the prognostic value of RDW in cancer patients. Relevant studies were picked out from the databases of Web of Science, Embase, Pubmed and Cochrane Library. A total of 16 papers with 4267 patients were included in this meta-analysis, and the combined results indicated that elevated RDW was associated with poor over survival (OS) (HR = 1.47, 95%CI:1.29-1.66), poor cancer-specific survival (CSS) (HR = 1.46, 95%CI:1.08-1.85), poor disease-free survival (DFS) (HR = 1.91, 95%CI:1.27-2.56), poor event-free survival (EFS) (HR = 2.98, 95%CI:0.57-5.39) and poor progress-free survival (PFS) (HR = 3.21, 95%CI:0.33-6.75) after treatment. Furthermore, the similar results were observed in subgroup analysis stratified by cancer type, cutoff value of RDW, sample size and ethnicity. In conclusion, this meta-analysis demonstrated that RDW may be a potential prognostic marker in patients with cancer, and high RDW may also be associated with poor outcomes.

show abstract

Section: Resultsmentioning

confidence: 99%

Prognostic value of RDW in cancers: a systematic review and meta-analysis

et al. 2016

View full text Add to dashboard Cite

show abstract

“…In relation to this limitation, the platelet cutoff value was arbitrarily set to the median value (234 × 10 9 /L) in order to maximize the statistical power of the analyses. In this context, a recent study of UTUC used a similar cutoff value (230 × 10 9 /L), although other studies have indicated that thrombocytosis (>400 × 10 9 /L) was associated with adverse clinicopathological features and a poor prognosis in cases of UTUC or urinary bladder UC . However, this cutoff value was not realistic in the present study, as only a few patients had both PD‐L1 positivity and a platelet count of >400 × 10 9 /L.…”

Section: Discussionmentioning

confidence: 99%

“…In relation to this limitation, the platelet cutoff value was arbitrarily set to the median value (234 × 10 9 /L) in order to maximize the statistical power of the analyses. In this context, a recent study of UTUC used a similar cutoff value (230 × 10 9 /L), 41 although other studies have indicated that thrombocytosis (>400 × 10 9 /L) was associated with The interaction was assessed using the Wald test and the cross-product of PD-L1 and platelet count (as a continuous variable) in the Cox model.…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of PD‐L1 expression in upper tract urothelial carcinoma varies according to platelet count

et al. 2018

View full text Add to dashboard Cite

Programmed cell death ligand‐1 (PD‐L1) is a ligand for programmed cell death‐1 (PD‐1) that negatively regulates T‐cell activation and plays a crucial role in suppressing anti‐tumor host immunity. Although PD‐L1 is a promising immunotherapy target in various cancers, including urothelial carcinoma (UC), the prognostic significance of PD‐L1 in UC is unclear. As platelets help protect tumor cells from immune elimination in the circulatory system, we hypothesized that tumor PD‐L1 and circulating platelets might synergistically promote tumor metastasis, and that the prognostic significance of PD‐L1 might vary according to platelet count. We immunohistochemically examined tumor PD‐L1 expression in 271 patients with upper tract UC, which revealed PD‐L1 positivity in 31 of 271 cases (11%). The associations of tumor PD‐L1 expression with outcomes varied among patients with high or low platelet counts (P interaction < 0.004). Among patients with high platelet counts (N = 136), PD‐L1 positivity (N = 15) was significantly associated with shorter metastasis‐free survival (univariate hazard ratio [HR]: 6.23, 95% confidence interval [CI]: 2.95‐13.1; multivariate HR: 2.68, 95% CI: 1.27‐5.64) and shorter overall survival (univariate HR: 4.92, 95% CI: 2.14‐11.3, multivariate HR: 2.78, 95% CI: 1.19‐6.51). In contrast, among patients with low platelet counts (N = 135), PD‐L1 positivity (N = 16) was not significantly associated with these outcomes. Our results suggest that tumor PD‐L1 expression and platelet count might interact and help regulate tumor progression. Although a larger prospective study is needed to validate our findings, this relationship is important to consider, as immunotherapies targeting the PD‐1/PD‐L1 axis have gained significant attention as promising therapies for UC.

show abstract

“…We appreciate the comments by Dr. Zeng on our published article. 1 First, patients with high red blood cell distribution width (RDW) had significantly lower body mass index than those with low RDW (22.96 ± 3.64 vs. 24.31 ± 3.74, P = 0.015) in our derivation cohort. However, some previous studies indicated that obesity was associated with high RDW.…”

Section: To the Editorsmentioning

confidence: 86%

Comment on: Does Red Blood Cell Distribution Width Really Have a Prognostic Role in Upper Tract Urothelial Carcinoma?

Cheng

et al. 2017

Ann Surg Oncol

Self Cite

View full text Add to dashboard Cite

TO THE EDITORSWe appreciate the comments by Dr. Zeng on our published article. 1 First, patients with high red blood cell distribution width (RDW) had significantly lower body mass index than those with low RDW (22.96 ± 3.64 vs. 24.31 ± 3.74, P = 0.015) in our derivation cohort. However, some previous studies indicated that obesity was associated with high RDW. 2 Second, patients with obstructive jaundice or severe coagulopathy were poor surgical candidates and therefore not included in the study. Third, in our article, renal function was already considered as a confounding factor and analyzed in the form of estimated glomerular filtration rate. Although diabetes mellitus was described to be associated with high RDW, opposite results were reported in Taiwanese population. 3 To our limited knowledge, no strong evidence suggested that high RDW is correlated with hypertension on multivariate analysis. No patient received antibiotics within 2 weeks before surgery, since those with active infection were excluded. Lastly, we used an automated counter device (Sysmex NX-9000) for RDW assessment.As mentioned in our article, many clinical conditions and factors may influence RDW level, and RDW could be a surrogate for them. We also assumed this was the reason why elevated RDW was more closely related to overall survival than cancer-specific survival. RDW is highly applicable in the clinical setting due to its easy accessibility, and we believe that RDW plays an important role in prognostic prediction for patients with upper tract urothelial carcinoma. REFERENCES 1. Cheng YC, Huang CN, Wu WJ, et al. The prognostic significance of inflammation-associated blood cell markers in patients with upper tract urothelial carcinoma. Ann. Surg. Oncol. 2016;23:343-51. 2. Fujita B, Strodthoff D, Fritzenwanger M, et al. Altered red blood cell distribution width in overweight adolescents and its association with markers of inflammation. Pediatr. Obes. 2013;8:385-91. 3. Chen PC, Sung FC, Chien KL, Hsu HC, Su TC, Lee YT. Red blood cell distribution width and risk of cardiovascular events and mortality in a community cohort in Taiwan. Am. J. Epidemiol. 15 2010;171:214-20.

show abstract

The Prognostic Significance of Inflammation-Associated Blood Cell Markers in Patients with Upper Tract Urothelial Carcinoma

Cited by 44 publications

References 35 publications

Prognostic value of RDW in cancers: a systematic review and meta-analysis

Prognostic value of RDW in cancers: a systematic review and meta-analysis

The prognostic value of PD‐L1 expression in upper tract urothelial carcinoma varies according to platelet count

Comment on: Does Red Blood Cell Distribution Width Really Have a Prognostic Role in Upper Tract Urothelial Carcinoma?

Contact Info

Product

Resources

About