Abstract
Activated platelets play a multifaceted role in tumorigenesis and progression. Platelet distribution width (PDW) is generally applied platelet parameters from routine blood test. Preoperative PDW has been considered a prognostic factor in many cancers. Nevertheless, the prognostic value of PDW in esophageal squamous cell carcinoma (ESCC) remains unknown. The study aimed to investigate whether preoperative PDW could serve as a prognostic factor in patients with ESCC. A total of 495 patients with ESCC undergoing curative surgery were enrolled. The relationship between PDW and clinical features in ESCC was analyzed using chi-square tests. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value. Overall survival (OS) and disease-free survival (DFS) stratified by PDW were evaluated by Kaplan–Meier method and log-rank test. Univariate and multivariate Cox regression were used to evaluate the prognostic effect of PDW. Of the 495 patients, elevated PDW was observed in 241(48.7%) of the patients, respectively. An elevated PDW was correlated with depth of tumor (T stage, P = 0.031), nerve infiltration (P = 0.016), hospital time after operation (P = 0.020), platelet (P < 0.001), red cell distribution width (P < 0.001), and aspartate transaminase (P = 0.001). Moreover, elevated PDW (PDW ≥ 13.4 fL) predicted a worse OS and DFS in patients with ESCC (both P < 0.001). Multivariate analyses revealed that PDW was independently associated with OS (hazard ratios 1.194; 95% confidence interval 1.120–1.273; P < 0.001) and DFS (hazard ratios 2.562; 95% confidence interval 1.733–3.786; P < 0.001). Our findings indicated that elevated PDW could serve as an independent worse survival in ESCC.
Highlights
Esophageal cancer is the sixth and fourth cause of cancer-related mortality in the world and in China[1,2], with esophageal squamous cell carcinoma (ESCC) accounting for 90% of all diagnosed esophageal cancer cases[3]
Some researches have showed that an increased pretreatment platelet count (PLT) or platelet-lymphocyte ratio (PLR) could serve as an independent prognosis factor in patients with ESCC18,19
Thrombocytosis is related to worse clinical outcome in patients with various cancers, including ovarian cancer, colorectal cancer, and pancreatic cancer[20,21,22]
Summary
Esophageal cancer is the sixth and fourth cause of cancer-related mortality in the world and in China[1,2], with ESCC accounting for 90% of all diagnosed esophageal cancer cases[3]. Several factors are related to the outcome of ESCC including TNM stage and tumor differentiation. In addition to activated platelets, an elevated platelet count that has been found in cancer patients seem to be related to a higher proportion of cancer-related venous thromboembolism[11]. Due to these mechanisms, platelets may serve as a potential therapeutic target[12]. Some researches have showed that an increased pretreatment PLT or PLR could serve as an independent prognosis factor in patients with ESCC18,19. Whether PDW is related to the prognosis in ESCC remains unknown. The aim of this retrospective study was to evaluate the prognostic value of PDW in ESCC, and to investigate the relationship between PDW and the clinical-pathological features
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