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Objectives To better define the relationship between platelet count and survival using a retrospective analysis in patients with thrombocytosis and metastatic renal cell carcinoma (RCC), some of whom had a shorter life expectancy than those with a normal platelet count. Patients and methods The records were reviewed of patients with stage IV RCC who had undergone a variety of adjuvant therapies after nephrectomy between 1972 and 1992. Entry criteria included a tissue diagnosis of RCC, at least one platelet count and a complete follow‐up until the time of death. Of 350 patients available for review, 259 met the entry criteria. Patients were divided into two groups: group 1 included 112 patients whose platelet counts remained at < 4 × 105/µL between the time of nephrectomy and the time of death; group 2 included 147 patients with at least one platelet count of > 4 × 105/µL (mean age in each group 57 years). Results The mean ( sd) survival for group 1 was 151 (34) months, compared with 92 (18) months for those in group 2. Using the log‐rank chi‐square test the difference in survival between the groups was significant (P = 0.005). Controlling for established prognostic indicators of pathological stage, nuclear grade and cell type, using Cox's regression technique, the difference in survival between the groups remained significant (P = 0.015). Conclusions These results suggest that patients with metastatic RCC who receive adjuvant therapy and have a persistently normal platelet count have a 64% longer life expectancy than those with thrombocytosis. The difference is highly statistically significant when controlled for nuclear grade, cell type and pathological stage.

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RARC has improved perioperative outcomes with equivalent oncological parameters when compared to open cystectomy. Patients ≥ 70-years old benefit from the robotic approach, particularly when compared to younger patients undergoing open cystectomy.

NCCN Categories of Evidence and Consensus Category 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus. Category 2A: The recommendation is based on lower-level evidence and there is uniform NCCN consensus. Category 2B: The recommendation is based on lower-level evidence and there is nonuniform NCCN consensus (but no major disagreement). Category 3: The recommendation is based on any level of evidence but reflects major disagreement. All recommendations are category 2A unless otherwise noted. Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Please Note These guidelines are a statement of consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network makes no representation or warranties of any kind regarding their content, use, or application and disclaims any responsibility for their applications or use in any way. These guidelines are copyrighted by the National Comprehensive Cancer Network. All rights reserved. These guidelines and the illustrations herein may not be reproduced in any form without the express written permission of the NCCN © 2009. Disclosures for the NCCN Bladder Cancer Guidelines Panel At the beginning of each NCCN guidelines panel meeting, panel members disclosed any financial support they have received from industry. Through 2008, this information was published in an aggregate statement in JNCCN and on-line. Furthering NCCN's commitment to public transparency, this disclosure process has now been expanded by listing all potential conflicts of interest respective to each individual expert panel member. Individual disclosures for the NCCN Bladder Cancer Guidelines Panel members can be found on page 39. (To view the most recent version of these guidelines and accompanying disclosures, visit the NCCN Web site at www.nccn.org.) These guidelines are also available on the Internet. For the latest update, please visit www.nccn.org. 8 Overview An estimated 68,810 new cases of urinary bladder cancer will be diagnosed in the United States (51,230 men and 17,580 women) in 2008. 1 Bladder cancer is the fourth most common cancer in men and is 3 times more common in men than in women in the United States. Furthermore, approximately 14,100 deaths (9950 men and 4150 women) from bladder cancer are anticipated. 1 Bladder cancers are rarely diagnosed in individuals younger than 40 years. Because the median age at diagnosis is 65 years, medical comorbidities are a frequent consideration in patient management. The clinical spectrum of bladder cancer can be divided into 3 categories that differ in prognosis, management, and therapeutic aims. The first c...