Abstract
ObjectiveTo compare the clinical utilities of the platelet count and platelet-lymphocyte ratio (PLR) for predicting survival in patients with cervical cancer.ResultsMultivariate analyses demonstrated that thrombocytosis and elevated PLR were found to be independent prognostic factors for progression-free survival (PFS, P = 0.0077, P = 0.044) and overall survival (OS, P = 0.025, P = 0.019) in separate Multivariate analyses. In the ROC analysis, the platelet count showed a significantly greater area under the ROC curve (AUC) value than that of PLR for predicting patient recurrence (0.5941 versus 0.5331, p = 0.018) and survival (0.6139 versus 0.5468, p = 0.029). In patients without thrombocytosis, elevated PLR correlated with shorter survival (PFS, P = 0.041; OS, P = 0.017). In contrast, PLR in patients with thrombocytosis did not provide prognostic information. We divided patients into 3 prognostic groups using platelet counts and PLR: high-risk (thrombocytosis with any PLR); intermediate-risk (elevated PLR without thrombocytosis); low-risk (none of the above), which allowed for individualized and accurate survival estimates.Materials and MethodsThe baseline characteristics and clinical outcomes of cervical cancer patients were identified. Patients were grouped according to their pretreatment platelet counts or PLR, and clinicopathological characteristics and patient survival were then compared between these groups. The clinical utilities of the platelet count and PLR were compared using a time-dependent receiver operating characteristic (ROC) analysis.ConclusionsPretreatment thrombocytosis and elevated PLR were identified as independent predictors in cervical cancer patients. Platelet counts were superior to PLR for predicting the prognosis of uterine cervical cancer patients. Our prognostic model consisting of platelet counts and PLR offers individualized survival estimates.
Highlights
Cervical cancer is the second most common type of cancer affecting women worldwide and has an annual incidence of 530,000 new cases
Multivariate analyses demonstrated that thrombocytosis and elevated platelet-lymphocyte ratio (PLR) were found to be independent prognostic factors for progression-free survival (PFS, P = 0.0077, P = 0.044) and overall survival (OS, P = 0.025, P = 0.019) in separate Multivariate analyses
In patients without thrombocytosis, elevated PLR correlated with shorter survival (PFS, P = 0.041; OS, P = 0.017)
Summary
Cervical cancer is the second most common type of cancer affecting women worldwide and has an annual incidence of 530,000 new cases. Current standard treatments for invasive cervical cancer are potentially curative, a significant number of patients develop recurrence and die of disease progression, with approximately 250,000 deaths being reported globally each year [1]. The identification of new prognostic factors for cervical cancer will improve our understanding of cervical cancer biology, contribute to the stratification of patients into risk groups, and identify those at a high risk of recurrence after the standard initial treatment. A recent study on ovarian cancer indicated that paraneoplastic thrombocytosis is due to the enhancements induced in hepatic thrombopoietin synthesis by tumor-derived IL6. The inhibition of thrombopoietin and IL-6 expression abrogated thrombocytosis in tumor-bearing mice and significantly enhanced the therapeutic efficacy of paclitaxel in mouse models of epithelial ovarian cancer [24]. Thrombocytosis is regarded as a prognostic indicator, and as a potential therapeutic target in human cancers
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