Preoperative thrombocytosis and poor prognostic factors in endometrial cancer.

Suttichai Heng,Mongkol Benjapibal

doi:10.7314/apjcp.2014.15.23.10231

Abstract

This study aimed to evaluate the prevalence of preoperative thrombocytosis and its prognostic significance in Thai patients with endometrial cancer. We retrospectively reviewed the medical records of 238 cases who had undergone surgical staging procedures between January 2005 and December 2008. Associations between clinicopathological variables and preoperative platelet counts were analyzed using Pearson's chi square or two- tailed Fisher's exact tests. Survival analysis was performed with Kaplan-Meier estimates. Univariate and Cox- regression models were used to evaluate the prognostic impact of various factors including platelet count in terms of disease-free survival and overall survival. The mean preoperative platelet count was 315,437/μL (SD 100,167/ μL). Patients who had advanced stage, adnexal involvement, lymph node metastasis, and positive peritoneal cytology had significantly higher mean preoperative platelet counts when compared with those who had not. We found thrombocytosis (platelet count greater than 400,000/μL) in 18.1% of our patients with endometrial cancer. These had significant higher rates of advanced stage, cervical involvement, adnexal involvement, positive peritoneal cytology, and lymph node involvement than patients with a normal pretreatment platelet count. The 5-year disease-free survival and overall survival were significantly lower in patients who had thrombocytosis compared with those who had not (67.4% vs. 85.1%, p=0.001 and 86.0% vs. 94.9%, p=0.034, respectively). Thrombocytosis was shown to be a prognostic factor in the univariate but not the multivariate analysis. In conclusion, presence of thrombocytosis is not uncommon in endometrial cancer and may reflect unfavorable prognostic factors but its prognostic impact on survival needs to be clarified in further studies.

Highlights

Haemostatic abnormalities are frequently observed in patients with malignancy
The 5-year disease-free survival and overall survival were significantly lower in patients who had thrombocytosis compared with those who had not (67.4% vs. 85.1%, p=0.001 and 86.0% vs. 94.9%, p=0.034, respectively)
Thirteen patients were excluded from the study because of missing pretreatment platelet counts, having concurrent other malignancy and conditions associated with thrombocytosis, so the remaining 238 patients were qualified for the final analysis

Summary

Introduction

Haemostatic abnormalities are frequently observed in patients with malignancy. Most patients with cancer have evidence of subclinical activation of blood coagulation. Cancer patients with advanced disease are characterized by a variety of venous thromboembolic disorders. Thrombocytosis (generally defined as platelet count greater than 400000/μL) has been demonstrated in a variety of solid tumors, such as lung, kidney, breast, esophagus, gastric, and colon cancers (Pedersen and Milman, 1996; Monreal et al, 1998; Ikeda et al, 2002; Taucher et al, 2003; Shimada et al, 2004; Erdemir et al, 2007). Preoperative thrombocytosis has been observed and found to be a poor prognostic variable in gynecological malignancies including vulvar, cervical, ovarian, and endometrial cancers (Hernandez et al, 1992; Zeimet et al, 1994; Menczer et al, 1996; Gucer et al, 1998; Hefler et al, 2000; Hernandez et al, 2000; Scholz et al, 2000; Tamussino et al, 2001; Li et al, 2004; Ayhan et al, 2006; Metindir and Dilek, 2009)

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