Abstract
Objectives: Activated platelets might play an important role in tumor progression. Mean platelet volume (MPV) has been used as a surrogate marker for platelet activation, and therefore its value as a marker of tumor prognosis has attracted recent attention. In this study, we aimed to critically evaluate the prognostic significance of the perioperative platelet count (COP), MPV and the MPV/COP ratio in head and neck cancer patients. Additionally, we explored the individual postoperative trajectory of these indices and their association with overall survival (OS) and disease-free survival (DFS). Methods: We retrospectively evaluated 122 head and neck squamous cell carcinoma patients receiving surgery with curative intent followed by postoperative radiotherapy. Platelet indices were measured preoperatively and on days 1 and 7 postoperatively. OS and DFS were analyzed using Kaplan–Meier estimators, the log-rank test and uni and multivariable Cox models. Cutoffs to dichotomize patients for Kaplan–Meier curves and log-rank tests were empirically chosen at the respective median. The median follow-up was 8.8 years. Results: The adjusted preoperative COP, MPV and MPV/COP ratio were not associated with disease outcome. A low postoperative COP and a high MPV/COP ratio on the first postoperative day were independently associated with worse OS and DFS. In comparison to the preoperative measurements, patients whose COP increased by day 1 post-op showed a better OS (hazard ratio (HR) per 50 G/L increase: 0.73, 95% confidence interval (CI): 0.58–0.93, p = 0.013) and DFS (HR per 50 G/L increase: 0.74, 95% CI: 0.58–0.94, p = 0.018) in multivariable analysis. Conclusions: Our results suggest that a low postoperative COP and a high MPV/COP ratio represent a negative prognostic factor for OS and DFS. Notably, patients with an increase in COP by day 1 post-op when compared to their preoperative value showed a significantly better OS and DFS.
Highlights
Head and neck squamous cell carcinoma (HNSCC) account for 63,500 annual deaths, with approximately 250,000 new cases every year in Europe alone [1]
HNSCCs are mainly associated with alcohol and tobacco use; more recently, the proportion of HNSCC cases attributable to human papillomavirus (HPV) infections has risen sharply
Late-stage HNSCCs are managed by surgery, followed by postoperative radiotherapy (PORT) or escalated to chemoradiotherapy for patients with extracapsular extension or R1 resection at surgery. [3,4] The eighth edition of TNM staging for oropharyngeal squamous cell carcinoma (OPSCC) includes immunohistochemical staining for p16 to identify OPSCCs associated with high-risk HPV
Summary
Head and neck squamous cell carcinoma (HNSCC) account for 63,500 annual deaths, with approximately 250,000 new cases every year in Europe alone [1]. Cancer surgery causes an acute inflammatory response, made up of two parts: an acute pro-inflammatory phase, followed by an anti-inflammatory phase [27] These two processes involve a complex cascade of events which includes the activation of platelets with the release of many growth factors, chemokines and cytokines, which may promote the tumor progression of residual or distant cancer cells [28]. The aim of this retrospective study was to determine the trajectory of platelet-associated markers pre and postoperatively, as well as how they are associated with overall and disease-free survival in HNSCC patients
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