Abstract
BackgroundThrombocytosis has been associated with poor ovarian cancer prognosis. However, comparisons of thresholds to define thrombocytosis and evaluation of relevant timing of platelet measurement has not been previously conducted.MethodsWe selected Tumor Registry confirmed ovarian, primary peritoneal, and fallopian tube cancer cases diagnosed between 1995–2013 from the Vanderbilt University Medical Center. Laboratory measured platelet values from electronic medical records (EMR) were used to determine thrombocytosis at three thresholds: a platelet count greater than 350, 400, or 450 × 109/liter. Timing was evaluated with 5 intervals: on the date of diagnosis, and up to 1, 2, 4, and 8 weeks prior to the date of diagnosis. Cox regression was used to calculate hazard ratios (HR) and confidence intervals (CI) for association with overall survival; adjustment included age, stage, grade, and histologic subtype of disease.ResultsPre-diagnosis platelet measures were available for 136, 241, 280, 297, and 304 cases in the five intervals. The prevalence of thrombocytosis decreased with increasing thresholds and was generally consistent across the five time intervals, ranging from 44.8–53.2 %, 31.6–39.4 %, and 19.9–26.1 % across the three thresholds. Associations with higher grade and stage of disease gained significance as the threshold increased. With the exception of the lowest threshold on the date of diagnosis (HR350: 1.55, 95 % CI: 0.97–2.47), all other survival associations were significant, with the highest reaching twice the risk of death for thrombocytosis on the date of diagnosis (HR400: 2.01, 95 % CI: 1.25–3.23).ConclusionsOur EMR approach yielded associations comparable to published findings from medical record abstraction approaches. In addition, our results indicate that lower thrombocytosis thresholds and platelet measures up to 8 weeks before diagnosis may inform ovarian cancer characteristics and prognosis.
Highlights
Thrombocytosis has been associated with poor ovarian cancer prognosis
Epithelial ovarian cancer (EOC) cases were classified by histologic subtype: serous/papillary (ICD-O codes 8050, 8260, 8441, 8442, 8450, 8451, 8460, 8461, 8462); mucinous (ICD-O codes 8470, 8471, 8472, 8473, 8480, 8490); endometrioid (ICD-O codes 8380), clear cell (ICD-O codes 8310, 8313); and other (ICD-O codes 8013, 8041, 8046, 8070, 8120, 8320, 8570, 8950, 8951, 8980, 9000)
Similar to Cox regression, Kaplan-Meier plots showed significant differences for cases with and without thrombocytosis within two weeks of diagnosis for all three thresholds evaluated (Fig. 2). In this large retrospective analysis of confirmed Tumor Registry cases from a single tertiary-care medical center with platelet measurments available in electronic medical records (EMR), we found that thrombocytosis, Table 4 Sensitivity Analysis of Thrombocytosis within 2 Weeks of Diagnosis and Overall Ovarian Cancer Survival
Summary
Thrombocytosis has been associated with poor ovarian cancer prognosis. Ovarian cancer is a rapidly progressive and lethal disease. Because of the anatomic location within the peritoneal cavity, ovarian cancer may be very advanced or even distantly metastatic before a patient experiences symptoms. These symptoms are often initially vague and non-specific, and may mimic a variety of benign conditions [2]. Ovarian cancer lacks a detectable pre-invasive stage that can be reliably evaluated by screening on a population level [2]. Over 60 % of ovarian cancer presents with advanced stage disease [1,2,3]. Recent US data indicate a dismal five year relative survival rate of 46 %; this is reduced to 28 % among cases with distant metastases [1]
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