Abstract
Preoperative thrombocytosis has been shown to be a marker of advanced disease and poor survival in gynecologic malignancies, specifically endometrial, ovarian, and cervical cancers. The aim of this study is to provide a focused mini-review on all the existing literature concerning the role of preoperative thrombocytosis as a prognostic factor in vulvar squamous cell cancer (SCC). A PubMed search (until February 20, 2018) of all peer-reviewed and English-published articles was conducted using the following keywords: platelet, thrombocytosis, and vulvar cancer. Only three studies met the search protocol. It is concluded that preoperative thrombocytosis does not emerge as a substantial independent prognostic factor of disease-free survival (DFS) and overall survival (OS) in patients with vulvar SCC. Nevertheless, the interpretation of this conclusion should be done with extreme cautiousness. This can be ascribed to the heterogeneity of the reported data across the three studies, especially concerns pertaining to methodological designs. Additional related uniform studies are needed, so that data can be usefully pooled into a well-characterized systematic review/meta-analysis study, in order to devise valid mathematically proven conclusions. For now, International Federation of Gynecology and Obstetrics/ Fédération Internationale de Gynécologie et d’Obstétrique staging (FIGO staging) and inguino-femoral lymph node involvement continue to be the most established independent prognostic factors of DFS and OS in patients with vulvar SCC.
Highlights
BackgroundTumor-platelet interactions in solid tumors have been previously characterized [1, 2]
Mean platelet count was 313 x 109/L Thrombocytosis was associated with anemia (p=0.0016) and leukocytosis (p=0.0001) Thrombocytosis was not associated with FIGO stage (p=0.549), metastatic groin LNs (p=0.94) and metastatic pelvic LNs (p=0.891) The 5-year overall survival (OS) was not statistically different (p=0.586) Cox regression: Thrombocytosis was not a statistically significant independent prognostic factor of disease-free survival (DFS) (p=0.2); tumor histology, tumor number and FIGO stage were so (p=0.003, p=0.003 & p=0.0001, respectively)
Median platelet count was 268.5 x 109/L Platelet count was statistically associated with tumor grade (p=0.01) but not age or FIGO stage Thrombocytosis was significantly associated with worse DFS (p=0.003) and OS (p
Summary
Tumor-platelet interactions in solid tumors have been previously characterized [1, 2]. A multivariate step-wise Cox regression analysis revealed that preoperative thrombocytosis was not a statistically significant independent prognostic factor of disease-free survival (DFS, p=0.2). No statistically significant correlations were identified between preoperative thrombocytosis and various clinicopathological prognostic parameters including tumor size/grade/depth, lympho-vascular space invasion, metastatic lymph node spread, and FIGO stage. There is, undoubtedly, a need for more uniform and strongly-designed studies on the role of preoperative thrombocytosis as a prognostic factor in vulvar SCC Later, these data can be usefully pooled into well-characterized systematic review and meta-analysis study protocols, in order to deduce valid mathematically proven conclusions
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