Abstract
PurposeThe role of mean platelet volume (MPV) as a predictor of outcomes in various cancer entities including colorectal cancer (CRC) has already been analyzed. However, data on the prognostic and predictive value of MPV in CRC over multiple lines of systemic therapy are missing.MethodsIn this retrospective single-center cohort study, 690 patients with UICC stage II, III or IV CRC receiving adjuvant and/or palliative chemotherapy were included. Primary endpoints in the adjuvant, palliative and best supportive care (BSC) setting were 3-year recurrence-free survival (RFS), 6-months progression-free survival (PFS), and 6-months overall survival (OS), respectively. Kaplan–Meier estimators, log-rank tests, and uni- and multivariable Cox models were used to analyze RFS, PFS and OS. A cut-off defining patients with low MPV was chosen empirically at the 25th percentile of the MPV distribution in the respective treatment setting.ResultsThree-year RFS was 76%. Median 6-month PFS estimates in 1st, 2nd and 3rd line therapy were 59, 37 and 27%, respectively. Median 6-month OS in BSC was 31%. Small platelets as indicated by low MPV did not predict for shorter RFS. In the first 3 palliative treatment lines a consistent association between low MPV and decreased 6-month PFS was not observed. In the BSC setting, patients with low MPV had numerically but not significantly shorter OS. Higher MPV levels did not consistently predict for ORR or DCR across the first 3 palliative treatment lines.ConclusionSmall platelets are not predicting CRC outcomes, and thus are hardly useful for influencing clinical decision making.
Highlights
Colorectal cancer (CRC) is the third most common cancer among both men and women
The average Mean platelet volume (MPV) levels were highly similar across all treatment settings (Table 1)
There is a lack of information on MPV and its impact on recurrence in the adjuvant setting as well as its association with outcome in metastatic CRC over multiple systemic treatment lines
Summary
Colorectal cancer (CRC) is the third most common cancer among both men and women. due to changes in risk factors and the increased attendance in screening programs in developed countries, incident rates haveClinical and Translational Oncology (2019) 21:1034–1043 been declining over the last years [1]. 30% of patients with UICC stage II or III experience recurrence after resection in curative intention, 80% of which have stage III disease at diagnosis [2]. 20% of all patients present with initially metastasized UICC stage IV disease at diagnosis [3]. It is crucial to find cost-effective and reliable prognostic biomarkers to identify patients at high risk of local or distant recurrence as well as for outcome prediction in metastasized CRC [4]. Mean platelet volume (MPV), a marker for platelet activation, is available in routine blood tests and has already been demonstrated to be a predictor of thrombotic events in patients with cardiovascular and cerebrovascular disease [5]. An association of MPV and the risk for venous thromboembolism in cancer patients has been found [6]. Platelets have been shown to promote cancer angiogenesis by releasing angiogenic growth factors such as vascular endothelial growth factor (VEGF) [8]
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