Abstract
Activated platelets promote tumor cell growth, angiogenesis, and invasion. Platelet activity can be inferred by platelet volume indices (PVIs), which include platelet distribution width (PDW), mean platelet volume (MPV), platelet distribution width-to-platelet count ratio (PDW/P), and mean platelet volume-to-platelet count ratio. Platelets and platelet-related markers, such as the platelet-to-lymphocyte ratio, have been found to be significant prognostic factors in patients with breast cancer. However, the role of PVIs for predicting survival in breast cancer remains unknown; hence, we performed this retrospective analysis of 275 patients with breast cancer. PVIs were compared with clinicopathological variables, and were assessed to identify independent indicators associated with disease-free survival (DFS) using the Cox proportional hazards model. An elevated PDW/P significantly correlated with age and HER2 status. Univariate analysis revealed that elevated PDW, MPV, and PDW/P as well as tumor size, nuclear grade, and lymph node involvement were significantly associated with inferior DFS rates (tumor size: p<0.01; nuclear grade, lymph node involvement, PDW, MPV, and PDW/P: p<0.05). On multivariate analysis, a large tumor size and elevated PDW/P were significant prognostic factors for DFS, with hazard ratios of 3.24 (95% confidence interval [CI]: 1.24–8.47) and 2.99 (95% CI: 1.18–7.57), respectively (p<0.05). Our study is the first to reveal that an elevated PDW/P significantly reduces DFS in patients with breast carcinoma. Measuring the PDW/P is simple, relatively inexpensive, and almost universally available using routine blood counts; this makes it an attractive biomarker for improved risk assessment.
Highlights
Breast cancer is the commonest malignant disease among Japanese women, and is a frequent cause of cancer-related death [1, 2]
We have shown that platelet-related markers, such as the platelet-to-lymphocyte ratio (PLR), are significant prognostic factors in patients with breast cancer [12,13]
Patients were divided into two groups with regards to each of platelet distribution width (PDW), MVP, platelet distribution width-to-platelet count ratio (PDW/P), and MVP/P according to the cutoff values established by receiver operating characteristics (ROC) analysis
Summary
Breast cancer is the commonest malignant disease among Japanese women, and is a frequent cause of cancer-related death [1, 2]. Platelet distribution width to platelet count ratio in breast cancer patients help guide clinical therapies in Europe and the United States, the Japanese National Health Insurance does not sustain their use in routine clinical practice owing to the high cost and regional availability of these kits [4]. Identifying prognostic breast cancer biomarkers that are low-cost and obtainable via routine blood counts is of great importance. More attention has been focused on the clinical significance of platelet activation in several malignancies [6]. We have shown that platelet-related markers, such as the platelet-to-lymphocyte ratio (PLR), are significant prognostic factors in patients with breast cancer [12,13]
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