Preoperative Platelet Count Research Articles

Dynamic changes of platelets before and after surgery predict the prognosis of patients with operable non-small cell lung cancer.

Purpose: To determine the prognostic significance of postoperative platelet/preoperative platelet ratio (PPR) in patients with operable non-small cell lung cancer (NSCLC), and assess its prognostic benefit compared to models relying solely preoperative platelet counts (PLT).Materials and Methods: A retrospective analysis of 403 patients who underwent radical resection of NSCLC in our institution from 2013 to 2018 was conducted to assess the prognostic significance of PLT and PPR. Progression-free survival (PFS) and overall survival (OS) were performed by the Kaplan-Meier method. Single-factor and multi-factor COX regression models were used to determine factors that affect long-term outcomes. Time-dependent ROC was used to evaluate the value of PPR in predicting the prognosis.Results: A significant association between high PLT and PPR and poor long-term patient survival outcomes was observed. The median PFS and OS of NSCLC patients with high PLT were 25 months and 29 months, which was significantly shorter than that of patients with low PLT (30 months and 33 months) (both P = 0.002). In addition, the median PFS and OS of NSCLC patients with high PPR were 18 months and 26.5 months, which was significantly shorter than that of patients with low PPR (33 months and 35 months) (both P<0.001). Univariate and Multivariate analysis using Cox regression model showed that PLT and PPR were independent factors affecting PFS and OS. Time-dependent ROC showed that the predictive capability of PLT and PPR preserved well when they were compared over time following surgery. The AUCs of PLT and PPR to predict 1-year PFS and OS, 3-year PFS and OS, 5-year PFS and OS stabilized between 0.528-0.607. PPR showed significantly higher accuracy than PLT in the prediction of 1-year and 3-year PFS and OS.Conclusions: Elevated PPR is significantly related to the adverse outcomes of patients with NSCLC. PPR can stably predict the long-term prognosis of patients, and can be used as a reliable indicator for evaluating the prognosis of patients with operable NSCLC.

Microvascular Invasion is the Significant Risk Factor in Solitary Hepatocellular Carcinoma Equal or Less than 2cm

Introduction: In American Joint Committee on Cancer (AJCC) 8th edition for hepatocellular carcinoma (HCC), stage T1a was redefined as solitary tumor≤2cm irrespective of microvascular invasion(MVI). We investigated the effect of MVI on the disease free (DFS) and overall survival (OS) of small HCC≤2cm, and conducted validation of AJCC 8th edition staging. Method: From January 2000 to December 2020 at Severance Hospital, Seoul, Korea, patients who underwent liver resection and pathologically confirmed with HCC≤2cm were enrolled. The clinicopathologic characteristics, surgical and oncologic outcomes were compared by dividing into two groups according to the MVI. DFS and OS were compared between two groups after propensity score matching (PSM). We evaluated risk factors affecting DFS and OS. Results: Total 265 patients were enrolled and 22 patients of vaguely nodular type were excluded. 156 patients were MVI(-) and 87 patients were MVI(+) and 66 patients of each groups after PSM were compared. Clinicopathologic characteristics did not differ significantly except for poorly differentiated rate in major (MVI-1.5%, MVI+13.6%, p=0.011) and worst differentiation (MVI-31.8%, MVI+57.6%, p<0.001). MVI(+) group showed significantly poor DFS than MVI(-) group(p=0.007), however OS did not show statistical difference (p=0.084). Blood loss more than 150cc (HR: 1.859, p=0.026) and C-viral etiology (HR: 3.485, p=0.001) were significant risk factor for DFS in multivariate analysis. Preoperative platelet count over 150k significantly reduced death rate (HR: 0.430, p=0.049). Conclusions: Microvascular invasion is the significant risk factor for recurrence in small HCC≤2cm. AJCC 8th edition, which underestimated the prognostic effect of MVI in small HCC, should be reevaluated.

A predictive model of perioperative myocardial infarction following elective spine surgery

Myocardial infarction (MI), and its predictive factors, has been an understudied complication following spine operations. The objective was to assess the risk factors for perioperative MI in elective spine surgery patients as a retrospective case control study. Elective spine surgery patients with a perioperative MI were isolated in the NSQIP. The relationship between MI and non-MI spine patients was assessed using chi-squared and independent samples t-tests. Univariate/multivariate analyses assessed predictive factors of MI. Logistic regression with stepwise model selection was employed to create a model to predict MI occurrence. The study included 196,523 elective spine surgery patients (57.1 yrs, 48%F, 30.4 kg/m2), and 436 patients with acute MI (Spine-MI). Incidence of MI did not change from 2010 to 2016 (0.2%–0.3%, p = 0.298). Spine-MI patients underwent more fusions than patients without MI (73.6% vs 58.4%, p < 0.001), with an average of 1.03 levels fused. Spine-MI patients also had significantly more SPO (5.0% vs 1.8%, p < 0.001) and 3CO (0.9% vs 0.2%, p < 0.001), but less decompression-only procedures (26.4% vs 41.6%, p < 0.001). Spine-MI underwent more revisions (5.3% vs 2.9%, p = 0.003), had greater invasiveness scores (3.41 vs 2.73, p < 0.001) and longer operative times (211.6 vs 147.3 min, p < 0.001). Mortality rate for Spine-MI patients was 4.6% versus 0.05% (p < 0.001). Multivariate modeling for Spine-MI predictors yielded an AUC of 83.7%, and included history of diabetes, cardiac arrest and PVD, past blood transfusion, dialysis-dependence, low preoperative platelet count, superficial SSI and days from operation to discharge. A model with good predictive capacity for MI after spine surgery now exists and can aid in risk-stratification of patients, consequently improving preoperative patient counseling and optimization in the peri-operative period.

A Simple Preoperative Blood Count to Stratify Prognosis in Isocitrate Dehydrogenase-Wildtype Glioblastoma Patients Treated with Radiotherapy plus Concomitant and Adjuvant Temozolomide.

Simple SummaryGlioblastoma (GB) is the most common primary malignant brain tumor in adulthood. The median survival of patients is approximately 15 months after the standard therapy including safe maximal resection followed by radiotherapy plus concomitant and adjuvant temozolomide. However, the survival times of GB patients undergoing this treatment are heterogeneous, with a small fraction living even beyond 36 months. The identification of a reliable and simple method for predicting whether patients will be short- or long-term survivors could assist in shaping individualized posttreatment surveillance. We show here that a simple, low-cost, relatively innocuous blood test before surgery can predict the survival outcomes of patients with isocitrate dehydrogenase (IDH)-wildtype GB treated with the standard therapy.Purpose: The survival times of glioblastoma (GB) patients after the standard therapy including safe maximal resection followed by radiotherapy plus concomitant and adjuvant temozolomide are heterogeneous. In order to define a simple, reliable method for predicting whether patients with isocitrate dehydrogenase (IDH)-wildtype GB treated with the standard therapy will be short- or long-term survivors, we analyzed the correlation of preoperative blood counts and their combined forms with progression-free survival (PFS) and overall survival (OS) in these patients. Methods: Eighty-five patients with primary IDH-wildtype GB treated with the standard therapy between 2012 and 2019 were analyzed retrospectively. Cox proportional hazards models and Kaplan–Meier analysis were used to investigate the survival function of preoperative hematological parameters. Results: Preoperative high neutrophil-to-lymphocyte ratio (NLR, >2.42), high platelet count (>236 × 109/L), and low red blood cell (RBC) count (≤4.59 × 1012/L) were independent prognostic factors for poorer OS (p = 0.030, p = 0.030, and p = 0.004, respectively). Moreover, a high NLR was an independent prognostic factor for shorter PFS (p = 0.010). We also found that, like NLR, preoperative high derived NLR (dNLR, >1.89) was of poor prognostic value for both PFS (p = 0.002) and OS (p = 0.033). A significant correlation was observed between NLR and dNLR (r = 0.88, p < 0.001), which had a similar prognostic power for OS (NLR: AUC = 0.58; 95% CI: [0.48; 0.68]; dNLR: AUC = 0.62; 95% CI: [0.51; 0.72]). Two scores, one based on preoperative platelet and RBC counts plus NLR and the other on preoperative platelet and RBC counts plus dNLR, were found to be independent prognostic factors for PFS (p = 0.006 and p = 0.002, respectively) and OS (p < 0.001 for both scores). Conclusion: Cheap, routinely ordered, preoperative assessments of blood markers, such as NLR, dNLR, RBC, and platelet counts, can predict the survival outcomes of patients with IDH-wildtype GB treated with the standard therapy.

Blood management in total hip arthroplasty: a nationwide trend analysis from 2011 to 2018.

With the advent of practice changes surrounding preoperative patient optimization and postoperative protocols, a marked reduction has been reported in blood transfusion rates following total hip arthroplasty (THA). Thus, the purpose of this study was to examine differences in the prevalence of preoperative anemia, thrombocytopenia, elevated international normalized ratio (INR), bleeding disorders, and pre- and postoperative blood transfusions over the last decade. From 2011 to 2018, the American College of Surgeons National Quality Improvement Program database was queried for all primary THA procedures (n = 208,796). The following continuous variables were examined using analysis of variance: preoperative hematocrit (HCT), platelet count, and INR. The following categorical variables were analyzed by chi-squared tests: anemia (HCT < 35.5% for females and < 38.5% for males), thrombocytopenia (platelet count < 150,000/µL), INR > 2.0, bleeding disorders, preoperative transfusions, and postoperative transfusions. There were decreases in preoperative anemia (2011: 16.2%; 2018: 11.4%, p < 0.001) and postoperative transfusions (2011: high = 22.2%; 2018: low = 1.3%, p < 0.001). Statistically significant but clinically irrelevant changes were observed in preoperative HCT (2011: low = 40.3, 2018: high = 41.1, p < 0.001), platelet count (2011: low = 248,700; 2018: high = 250,100, p < 0.001), thrombocytopenia (2011: high = 4.9%; 2018: low = 4.3%, p = 0.036), INR > 2.0 (2011: high = 1.1%; 2018: low = 0.7%, p = 0.001), bleeding disorders (2011: high = 2.9%; 2018: low = 2.0%, p < 0.001), and preoperative transfusions (2011: high = 0.2%; 2018: low = 0.1%, p = 0.007). Large decreases in the number of patients with preoperative anemia and those receiving postoperative blood transfusion were observed during the study period. Future investigation is needed to ascertain whether this is due to patient optimization, practice changes, "cherry-picking" of healthy patients, or a combination of these factors. III.

Effi cacy of splenectomy in primary immune thrombocytopenia

Introduction. Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by isolated thrombocytopenia. Splenectomy is one the most effective treatment methods for this disorder.Aim — to evaluate the effi cacy and safety of a splenectomy in patients with primary immune thrombocytopenia.Subjects and methods. 111 patients (31 males, 80 females) with primary immune thrombocytopenia who were hospitalized to perform laparoscopic splenectomy were included in a prospective study conducted at the National Research Center for Hematology from 2015 to 2019. Disease duration from onset to splenectomy was from 1 month to 51 years. Response to the splenectomy, complications, and correlation with immediate preoperative platelet count were analyzed.Results. Complete response was achieved in 79 (71.2 %) cases, a partial response was achieved in 11 (9.9 %) cases, and in 21 (18.9 %) cases there was no response. Immediate preoperative platelet count was signifi cantly higher in patients with complete response in comparison with the group with no response, median (95% CI): 47 (35–58) vs 16 (9–20), p &lt; 0.001.Multivariate analysis (logistic regression) was performed. According to this regression, a risk factor for an unfavorable response was detected — males &gt; 60 years of age, p = 0.05; RR (95% CI): 2.0 (0.9–7.1). A predictor of unfavorable response was identifi ed – immediate preoperative platelet count &lt; 23 × 109/l (cutoff point determined in ROC-analysis); p = 0.001, RR (95% CI): 2.5 (1.1–8.6). The probability of complete response was lower with the number of treatment lines prior to splenectomy (weak inverse correlation: r S = −0.30; p = 0.01). The frequency of postoperative complications was 12.6 %. According to our follow-up data, a complete response was preserved in 66/79 (83.5 %) of patients, with a follow-up of 2.7 years.Conclusion. Splenectomy is an effective and safe treatment method for ITP. Factors of unfavorable response were identifi ed: males &gt; 60 years of age and immediate preoperative platelet count &lt; 23 × 109/l. It is safe to perform splenectomy regardless of effectiveness of preoperative splenectomy treatment and platelet count.

The clinical significance of preoperative serum fibrinogen levels and platelet counts in patients with gallbladder carcinoma

BackgroundGallbladder carcinoma (GBC) was the most common malignancy of biliary tract. Patients with malignancies frequently present with activated coagulation pathways, which might potentially related to tumor progression and prognosis. The purpose of the study was to investigate the clinical significance of preoperative serum fibrinogen levels and platelet counts in GBC patients.Methods The preoperative fasting serum fibrinogen levels and platelet counts of 58 patients with GBC were measured by AUV2700 automatic biochemical analyzer, as well as 60 patients with cholesterol polyps and 60 healthy volunteers. Kaplan–Meier survival analysis was applied to show the correction between fibrinogen levels and outcome after surgery.ResultsThe fibrinogen levels of patients with GBC were significantly higher than healthy gallbladder and cholesterol polyp of gallbladder (p < 0.001 and p < 0.001, respectively). In GBC, fibrinogen levels were associated with tumor depth (p = 0.001), lymph node metastasis (p = 0.002), distant metastasis (p < 0.001) and Tumor Node Metastasis (TNM) stage (p < 0.001). The levels in TNM stage IV disease were significantly higher than stage III or stage I + II disease (p = 0.048 and p < 0.001, respectively), and in TNM stage III disease were significantly higher than stage I + II disease (p = 0.002). Furthermore, the overall survival was better in low fibrinogen level group than in high fibrinogen level group (p < 0.001). However, thrombocytosis was not significantly associated with overall survivals (p > 0.05) in multivariate analysis.ConclusionsThe preoperative serum fibrinogen levels and platelet counts might be reliable biomarkers for the occurance of disease, tumor depth, lymph node metastasis, distant metastasis and advanced TNM stage in patients with GBC. The serum fibrinogen levels might be a prognostic factor to predict outcome for GBC patients suffering from surgery treatment. Anticoagulation therapy might be considered to control cancer progression in future studies.

Dentoalveolar Procedures in Immune Thrombocytopenia; Systematic Review and an Institutional Guideline.

Background Dentoalveolar procedures in immune thrombocytopenia (ITP) pose a risk of bleeding due to thrombocytopenia and infection due to immunosuppressive treatments. We aimed to systematically review the safety and management of dentoalveolar procedures in ITP patients to create practical recommendations. Methods PubMed, Embase, Cochrane, and Cinahl were searched for original studies on dentoalveolar procedures in primary ITP patients. We recorded bleeding- and infection-related outcomes and therapeutic strategies. Clinically relevant bleeding was defined as needing medical attention. Results Seventeen articles were included, of which 12 case reports/series. Overall, the quality of the available evidence was poor. Outcomes and administered therapies (including hemostatic therapies and prophylactic antibiotics) were not systematically reported. At least 73 dentoalveolar procedures in 49 ITP patients were described. The range of the preoperative platelet count was 2 to 412 × 10 9 /L. Two clinically relevant bleedings (2%) were reported in the same patient of which one was life-threatening. Strategies used to minimize the risk of bleeding were heterogeneous and included therapies to increase platelet count, antifibrinolytics, local measures, and minimally invasive techniques. Reports on the occurrence of bleedings due to anesthetics or infection were lacking. Conclusion Based on alarmingly limited data, clinically relevant bleedings and infections after dentoalveolar procedures in ITP patients seem rare. Awaiting prospective and controlled studies to further evaluate these risks and the efficacy of therapeutic interventions, we provided our institutional guideline to guide the management of dentoalveolar procedures in ITP patients.

Alteration of prognostic efficacy of albumin-bilirubin grade and Child-Pugh score according to liver fibrosis in hepatocellular carcinoma patients with Child-Pugh A following hepatectomy.

BackgroundThe albumin‐bilirubin (ALBI) grade was developed to predict the prognosis of patients with hepatocellular carcinoma (HCC), which can stratify the prognosis even in HCC patients with Child‐Pugh A. We evaluated the prognostic efficacy of the ALBI grade and Child‐Pugh classification in HCC patients with Child‐Pugh A stratified by the presence or absence of advanced fibrosis or a preoperative biomarker for advanced fibrosis.MethodsWe retrospectively analyzed 490 consecutive HCC patients with Child‐Pugh A who underwent initial hepatectomies. The accuracy of prognostic prediction using both models was compared by the presence or absence of advanced fibrosis (F3‐4) and its predictor, the preoperative platelet count (PLT).ResultsThe prognostic accuracy of the ALBI grade was better in patients without advanced fibrosis (F3‐4; likelihood ratio: 4.39, corrected Akaike information criterion [AICc]: 453.0, P = .074), but Child‐Pugh score was better in the advanced fibrosis group (likelihood ratio: 10.67, AICc: 915.2, P = .0014). In the high PLT group (≥140 × 103/μL), the prognostic accuracy using the ALBI grade was better in overall survival (OS) and relapse‐free survival (RFS), but in the low PLT group, the Child‐Pugh score was the more accurate model in OS and RFS.ConclusionsDepending on the degree of fibrosis or preoperative PLT, the ALBI grade and Child‐Pugh score may provide more accurate prognoses after initial hepatectomy in HCC patients with Child‐Pugh A.

Is Continuing Anticoagulation or Antiplatelet Therapy Safe Prior to Kidney Transplantation?

BackgroundPatients undergoing kidney transplantation are often placed on anticoagulation or antiplatelet therapy, and their perioperative management is often challenging. This study aimed to determine the safety of continuing anticoagulation or antiplatelet therapy prior to kidney transplantation. The primary outcome was bleeding after transplantation.Material/MethodsPatients who underwent kidney transplantation between January 2017 and July 2019 were included and divided into 3 groups: pretransplant anticoagulation with warfarin (WARF; n=23); pretransplant antiplatelet therapy with clopidogrel/aspirin (ASA/CLOP; n=32); and control (CTL; n=197). Patients received kidneys from live or deceased donors. Preoperative INRs and platelet counts were compared to ensure therapeutic anticoagulation in the warfarin group and no significant platelet count variation among groups. The primary outcome was graft exploration for bleeding at 3 and 6 months after transplantation. Secondary outcomes included perioperative transfusion requirements, prolonged length of stay (>7 days), and outcomes at 3 and 6 months after transplantation, including hemodialysis and rejection rates and creatinine levels.ResultsPretransplant INR was significantly greater in the warfarin group (CTL 1.1, WARF 2.2, ASA/CLOP 1.2; P<0.01). There were no differences in pretransplant platelet count (CTL 202×103, WARF 186×103, ASA/CLOP 194×103; P=0.31), graft exploration for bleeding at 3 (CTL 3%, WARF 0%, ASA/CLOP 3%; P=0.69) and 6 months after transplantation (CTL 1%, WARF 4%, ASA/CLOP 0%; P=0.12), or perioperative blood transfusion requirements (CTL 4%, WARF 4%, ASA/CLOP 14%; P=0.13). Prolonged length of stay was similar (CTL 24%, WARF 26%, ASA/CLOP 44%; P=0.08). There were no significant differences among groups at 3 months in dialysis (CTL 2%, WARF 0%, ASA/CLOP 0%; P=0.71), creatinine (CTL 1.5 mg/dL, WARF 1.7 mg/dL, ASA/CLOP 1.7; P=0.13), or rejection (CTL 6%, WARF 0%, ASA/CLOP 0%) or at 6 months in dialysis (CTL 3%, WARF 0%, ASA/CLOP 0%; P=0.49), creatinine (CTL 1.5 mg/dL, WARF 1.7 mg/dL, ASA/CLOP 1.5; P=0.49), or rejection (CTL 1%, WARF 0%, ASA/CLOP 3%).ConclusionsContinuing anticoagulation or antiplatelet was safe in not increasing bleeding complications or perioperative transfusion requirements. Outcomes were similar at 3 and 6 months among groups. This strategy avoids exposing patients to risk of thrombosis if treatment is held and simplifies proceeding to transplantation.

A prognostic model for the preoperative identification of patients at risk for receiving transfusion of packed red blood cells in cardiac surgery.

Patients undergoing cardiothoracic surgery are at substantial risk for blood transfusion. Increased awareness and patient blood management have resulted in a significant reduction over the past years. The next step is preoperative treatment of patients at high risk for packed red blood cells (RBC) transfusion, with the ultimate goal to eventually prevent RBC transfusion. A prediction model was developed to select patients at high risk for RBC transfusion. Data of all patients that underwent cardiac surgery in our center between 2008 and 2013 (n= 2951) were used for model development, and between 2014 and 2016 for validation (n= 1136). Only preoperative characteristics were included in a multinomial regression model with three outcome categories (no, RBC, other transfusion). The accuracy of the estimated risks and discriminative ability of the model were assessed. Clinical usefulness was explored. Risk factors included are sex, type of surgery, redo surgery, age, height, body mass index, preoperative hemoglobin level, and preoperative platelet count. The model has excellent discriminative ability for predicting RBC transfusion versus no transfusion (area under the curve [AUC]=94%) and good discriminative ability for RBC transfusion versus other transfusion (AUC=84%). With a cut-off value of RBC risk of 16.8% and higher, the model is well able to identify a high proportion of patients at risk for RBC transfusion (sensitivity=87.1%, specificity=82.3%). In the current study, a prediction tool was developed to be used for risk stratification of patients undergoing elective cardiac surgery at risk for blood transfusions.

Oral Is as Effective as Intravenous Tranexamic Acid at Reducing Blood Loss in Thoracolumbar Spinal Fusions: A Prospective Randomized Trial.

A prospective randomized trial at a university affiliated tertiary medical center between February 2017 and March 2020. The aim of this study was to compare perioperative blood loss in patients undergoing elective posterior thoracolumbar fusion who were treated with IV versus PO TXA. The use of antifibrinolytic agents such as tranexamic acid (TXA) to decrease operative blood loss and allogenic blood transfusions is well documented in the literature. Although evidence supports the use of intravenous (IV) and topical formulations of TXA in spine surgery, the use of oral (PO) TXA has not been studied. A total of 261 patients undergoing thoracolumbar fusion were randomized to receive 1.95 g of PO TXA 2 hours preoperatively or 2 g IV TXA (1 g before incision and 1 g before wound closure) intraoperatively. The sample was further stratified into three categories based on number of levels fused (one-to two-level fusions, three to five, and more than five). The primary outcome was the reduction of hemoglobin. Secondary outcomes included calculated blood loss, drain output, postoperative transfusion, complications, and length of hospital stay. Equivalence analysis was performed with a two one-sided test. One hundred thirty-seven patients received IV and 124 received PO TXA. The average age was 62 ± 13 years (mean ± SD), including 141 females and 120 males. Revision cases comprised of 67% of the total sample. Patient demographic factors were similar between groups except for weight, BMI, and preoperative platelet count. The mean reduction of hemoglobin was similar between IV and PO groups (3.56 vs. 3.28 g/dL, respectively; P = 0.002, equivalence). IV TXA group had a higher transfusion rate compared to PO TXA group (22 patients [19%] vs. 12 patients [10%]; P = 0.03). In addition, IV group had longer length of stay (LOS) than PO group (4.4 vs. 3.7 days; P = 0.02). Patients treated with IV and PO TXA experienced the same perioperative blood loss after small and large spinal fusions. In subgroup analysis, the intermediate (three to five level) spinal fusions had less blood loss with PO TXA than IV TXA. Given its lower cost, PO TXA represents a superior alternative to IV TXA in patients undergoing elective posterior thoracolumbar fusion and may improve health care cost-efficiency in the studied population.Level of Evidence: 1.

Abstract 476: Clinical characteristics and outcome of pathologic N0 NSCLC patients with false positive on FDG PET-CT

Abstract Background Preoperative Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET-CT) is a non-invasive and useful diagnostic tool to evaluate mediastinal lymph node metastasis in lung cancer. However, there are often false-positive lymph node cases in FDG PET-CT. We enrolled patients diagnosed with clinical N1-3 on FDG PET-CT, but pathologic N0 after mediastinal lymph node dissection. We aimed to explore clinical characteristics and outcome of pathologic N0 non-small cell lung cancer patients with false positive mediastinal lymph nodes on FDG PET-CT. Methods We enrolled total 147 patients who took pre-operative PET-CT scan and mediastinal lymph node dissection. Among them, 40 patients were diagnosed with clinical N1-3 by PET-CT. These patients were re-evaluated by post-operative pathologic nodal metastasis and divided into false-positive group and others. We retrospectively analyzed clinicopathologic features and recurrence free survival among patients diagnosed with same pathologic stage. Results Among 40 patients diagnosed with clinical N1-3 on FDG PET-CT, 19 (47.5%) patients were pathologic N0, which means false positive lymph node by PET-CT. Preoperative absolute platelet count (279.79 x 109/L versus 218.67 x 109/L; P = 0.012) and Platelet-Lymphocyte Ratio (PLR, 16.93 versus 11.53; P = 0.012) were significantly higher in the patients with pathologic N0. Among patients with pathologic N0, the presence of lymphatic invasion was significantly lower than other group (31.6% versus 85.7%; P = 0.001). Recurrence free survival was significantly shorter in pathologic N0 patients than those with same pathologic stage (P = 0.037). In addition, cox regression analysis showed smoking status (P = 0.045) and lymphatic invasion (P = 0.047) were independent factors for recurrence, significantly. Conclusions In conclusion, higher absolute platelet count, PLR and lower proportion of lymphatic invasion were associated with false positive mediastinal lymph node on preoperative FDG PET-CT. Furthermore, recurrence free survival was significantly shorter in these patients than those with same pathologic stage. In the future, preoperative biomarkers to predict pathologic nodal status need to be investigated. Citation Format: Changdong Yeo, Hye Seon Kang, Sang Haak Lee. Clinical characteristics and outcome of pathologic N0 NSCLC patients with false positive on FDG PET-CT [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 476.

External validation of risk prediction platform for pancreatic fistula after pancreatoduodenectomy using artificial intelligence

Postoperative pancreatic fistula (POPF) is a life-threatening complication following pancreatoduodenectomy (PD). We previously developed artificial intelligence (AI)-based risk prediction platform for POPF after PD. This study aims to externally validate the formerly developed platform. Between January 2007 and December 2016, a total of 1576 patients who underwent PD in Seoul National University Hospital, Ilsan Paik Hospital, and Boramae Medical Center were retrospectively reviewed for external validation. POPF was defined according to the 2016 updated International Study Group of Pancreatic Fistula. The individual risk scores for POPF were calculated using AI risk prediction platform by Samsung Medical Center. The predictive ability was evaluated with a Receiver Operating Characteristic curve and the area under the curve (AUC). In order to obtain the optimal predictive value, we performed backward elimination in accordance with the results from the AI development process. There were 270 (17.1%) patients who developed POPF in the validation cohort. After backward elimination, each AUC varied from 0.585 to 0.672. The 13 risk factors representing the maximal AUC were pancreatic duct diameter, body mass index, pre-operative serum albumin, amount of intra-operative fluid infusion, age, pre-operative platelet count, location of tumor, combined venous resection, co-existing pancreatitis, pre-operative serum lipase, neoadjuvant radiotherapy, American Society of Anesthesiologists' score, and sex. We performed external validation of previously developed AI platform for predicting POPF. This user-friendly platform could be used to discriminate individual risk of POPF. Further research is needed to investigate other potential risk factors and to improve the predictability of the platform.

Demographic, Clinical and Laboratory Features, Management and Outcome of Immune Thrombocytopenia (ITP) in Greece: The National ITP Registry of the Hellenic Society of Hematology

Immune thrombocytopenia (ITP) is a heterogeneous autoimmune disorder mediated by platelet antibodies thought to accelerate platelet destruction while inhibiting also their production. ITP may be primary (with no apparent underling etiology) or secondary to another disorder.ITP features in the general Greek population have not been properly investigated. The purpose of the study is to access systematically, for the first time, the demographic, clinical, laboratory, treatment-related characteristics and outcome of ITP in Greece, based on the national database (ITP registry) operated under the auspices of the Hellenic Society of Hematology, managed by the Hematology Department of the University of Crete (UoC) and supported by the Center of Information and Communications Technologies of the UoC.From 2013 to June 2017 718 adult patients from 16 different hospitals throughout Greece were registered. The median age at diagnosis was 53 years (range, 18-97 years). Two peaks were observed at 19-30 and 71-80 years of age. The female to male ratio was 1.9:1. The median platelet (PLT) count at diagnosis was 15x103/ml. 56.6% of patients presented with bleeding manifestations, including cutaneous bleeding (90.1%), oral cavity bleeding (29.1%), epistaxis (12.6%), menorrhagia (11.3%) and gastrointestinal bleeding (8%). 454 patients (63.2%) had primary ITP and 264 (36.8%) secondary ITP. Among the latter cases, 22.34% were related to infectious agents, 29.54% to drugs, 7.95% to collagen vascular diseases and 16.28% to cancer. Patients with positive ANA antibodies with no evidence of any underlying diseases were included in the primary ITP group. The main patient comorbidities were hypertension (19.95%), thyroid disease (11.32%) and cardiovascular disease (9.1%). Bleeding manifestations were significantly more frequent in the secondary ITP group as compared to the primary ITP group (P<0.0001), although there was no difference in PLT count on diagnosis. Treatment was administered in 657 patients on diagnosis. Specifically, 91.78% of patients were treated with corticosteroids (CS), 47.48% with i.v. IgG, 44.29% with both and 21.91% received other treatments, including rituximab (4.8%), anti-D immunoglobulin (4.14%) and thrombopoietin receptor agonists (2.81%). 91.62% of patients responded to the initial treatment.At 1 year after ITP diagnosis data from 156 patients was available. Among these patients 44% had persistent ITP, while the rest achieved PLT count 100,000/μl (recovery) either spontaneously (27%) or with a disease modifying treatment (29%). There was no difference in median age, median PLT count, frequency and severity of bleeding manifestations nor in ANA antibody positivity on diagnosis between patients with persistent ITP and those with spontaneous recovery. All patients in the latter group were female, as compared to 53% in the former group (P<0.0001).59 patients (36 women and 23 men) with a median age of 47 years (range, 23-94) have been splenectomized. The median time from diagnosis to splenectomy was 11 months (range, 1.5-258) and the median pre-operative PLT count was 32,500/μl (range, 5-200,000/μl). The outcome after splenectomy was assessed in 19/59 patients, for whom evaluable data were provided. 74% of patients responded to splenectomy. Responders did not differ from non-responders in female to male ratio, nor in the median pre-preoperative PLT count nor in the median PLT number on diagnosis. A significant higher proportion of responders to splenectomy had responded to first-line treatment as compared to non-responders (P=0.0374). Furthermore, responders had received significantly fewer number of therapies before splenectomy (P=0.0361).In conclusion, primary ITP is more frequent than secondary ITP in Greece. ITP displays a bimodal distribution, with peaks at 19-30 and 71-80 years of age, it has a female predominance and presents with bleeding manifestations in half of patients. Treatment is mainly based on CS and/or i.v IgG. Splenectomy is effective in about 2/3 of patients. At one year of diagnosis 27% of patients achieved spontaneous recovery. Registration and follow-up of a larger number of patients and evaluation of response to various treatments are anticipated to extend our knowledge on the pathophysiology and natural history of ITP and identify predictive factors of the disease course, possibly associated with peculiarities of the Greek population. DisclosuresNo relevant conflicts of interest to declare.

Safety and Threshold Analysis of Preoperative Platelets in Right Lobe Living Donors for Liver Transplantation

BackgroundLow perioperative platelet count is a powerful independent risk factor for posthepatectomy liver failure. Usually, categorical effect of thrombocytopenia was taken into account; upper thresholds were not studied in depth, exclusively in living liver donors. MethodsLiving liver donors who underwent right hepatectomy were included. Preoperative characteristics of donors were identified and examined to predict posthepatectomy liver failure. To eliminate selection bias, one-to-one propensity score matching was performed. ResultsThere were a total of 139 living donors and 40 (29%) donors developed posthepatectomy liver failure in the aftermath of the operation. Remnant liver volume ratio and preoperative platelet count were identified as adjustable independent risk factors (OR: 0.89 and 0.99, 95% CI: 0.79–0.99 and 0.98–0.99, respectively). After propensity score matching, odds ratio of preoperative platelet count was 0.99 (95% CI: 0.98–1.00). ConclusionsPreoperative platelet count, in addition to remnant liver volume ratio, can be used as a surrogate marker to predict the risk of posthepatectomy liver failure in living liver right lobe donors. Probability curves figured out from logistic regression analysis, in this regard, provided an explicit perspective of platelets having a decisive role on liver donor safety. Thus, remaining in safer remnant liver volume ratio limits with respect to preoperative platelet count should be addressed in safe donor selection strategies.

Clinical Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Liver Transplantation

Objective: Liver transplantation has been reported to be a predictor of patient survival in acute coronary syndrome and various malignancies, including hepatocellular carcinoma (HCC). In a previous study, it was demonstrated that high Platelet-to-Lymphocyte Ratio (PLR) values before treatment are an independent prognostic factor predicting poor survival in patients with large HCC. We aimed to investigate whether preoperative neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and thrombocyte count are prognostic factors for posttransplantation mortality or graft function in patients who underwent liver transplantation in the clinic.&#x0D; Material and Methods: The data of 40 patients who underwent liver transplantation in the clinic during January 2018–December 2020 were retrospectively analyzed and included in the study.&#x0D; Results: The mean age of the 40 patients included in the study was 51.1 ± 11.7 years. Of these, 27 (67.5%) were male, and 13 (32.5%) were female. Living-donor liver transplantation was performed in 33 patients, whereas cadaveric liver transplantation was performed in seven patients. The mean ejection fraction (EF) was 56.7% ± 3.2%, and the mean model for end-stage liver disease score was 22.4 ± 5.4. After one year of follow-up, 10 out of 40 patients (25%) died after orthotopic liver transplantation. The mean preoperative neutrophil count was found to be 5.7 ± 2.4 × 109/l in non-surviving patients and 3.1 ± 2.05 × 109/l in surviving patients. It was found that mortality increased in patients with high preoperative neutrophil values (NLR &gt; 3.7, p &lt; 0.001) and preoperative platelet count (&lt;79.52 × 109/L, p &lt; 0.001).&#x0D; Conclusion: Preoperative neutrophilia, thrombocytopenia and high NLR values may predict poor prognosis in patients undergoing OLT.

Preoperative platelet transfusions: A retrospective review of pediatric patients with thrombocytopenia, 2011–2016

BackgroundThrombocytopenia is a common perioperative clinical problem and preoperative platelet transfusion prior to surgery is standard practice. Recent platelet trials and literature reviews have found no association between platelet count and bleeding incidence except when platelet count is extremely low. Our aim was to evaluate the bleeding risk and the overall platelet transfusion management among pediatric patients with severe thrombocytopenia based on whether they were preoperatively transfused versus transfused at time of incision. MethodsThis is a retrospective analysis of pediatric patients with a platelet count ≤50 × 109/L in the 12 h prior to surgery at a single tertiary pediatric hospital from 2011 to 2016. Eligible patients were ≤21 years old. Patients with necrotizing enterocolitis and neonates were excluded. The primary outcome was postoperative bleeding complications. Additional outcomes were preoperative platelet change and weight adjusted transfusion volumes. ResultsA total of 37 patients were included in this analysis of which 29 (78%) received preoperative platelet transfusions within 12 h prior to surgery. No postoperative bleeding complications occurred 30 days after operation, regardless of preoperative transfusion status. There was no significant difference in platelet change by preoperative transfusion status and preoperative transfusion volume was a poor predictor of change in preoperative platelet count (crude: r2=0.19, age/gender adjusted: r2=0.48). ConclusionPatients transfused at time of surgical procedure did not have an increased risk of bleeding over those preoperatively transfused. This finding is in agreement with previous studies in adult populations, supporting the safety of deferring platelet transfusions until the time of incision for thrombocytopenic pediatric surgical patients.Level of evidence: III

A Radiomics Nomogram for Preoperative Prediction of Early Recurrence of Small Hepatocellular Carcinoma After Surgical Resection or Radiofrequency Ablation

BackgroundPatients with small hepatocellular carcinoma (HCC) (3 cm) still have a poor prognosis. The purpose of this study was to develop a radiomics nomogram to preoperatively predict early recurrence (ER) (2 years) of small HCC.MethodsThe study population included 111 patients with small HCC who underwent surgical resection (SR) or radiofrequency ablation (RFA) between September 2015 and September 2018 and were followed for at least 2 years. Radiomic features were extracted from the entire tumor by using the MaZda software. The least absolute shrinkage and selection operator (LASS0) method was applied for feature selection, and radiomics signature construction. A rad-score was then calculated. Multivariable logistic regression analysis was used to establish a prediction model including independent clinical risk factors, radiologic features and rad-score, which was ultimately presented as a radiomics nomogram. The predictive ability of the nomogram was evaluated using the area under the receiver operating characteristic (ROC) curve and internal validation was performed via bootstrap resampling and 5-fold cross-validation method.ResultsA total of 53 (53/111, 47.7%) patients had confirmed ER according to the final clinical outcomes. In univariate logistic regression analysis, cirrhosis and hepatitis B infection (P=0.015 and 0.083, respectively), hepatobiliary phase hypointensity (P=0.089), Child-Pugh score (P=0.083), the preoperative platelet count (P=0.003), and rad-score (P<0.001) were correlated with ER. However, after multivariate logistic regression analysis, only the preoperative platelet count and rad-score were included as predictors in the final model. The area under ROC curve (AUC) of the radiomics nomogram to predict ER of small HCC was 0.981 (95% CI: 0.957, 1.00), while the AUC verified by bootstrap is 0.980 (95% CI: 0.962, 1.00), indicating the goodness-of-fit of the final model.ConclusionsThe radiomics nomogram containing the clinical risk factors and rad-score can be used as a quantitative tool to preoperatively predict individual probability of ER of small HCC.

Elevated platelet count as a possible prognostic marker of survival in patients with head and neck tumours

The association between cancer-related thrombocytosis and worse survival has been described with a variety of solid neoplasms. However, only limited data are available on the prognostic significance of elevated platelet count in head and neck tumours. We aimed to investigate the correlation between the survival of patients with head and neck cancer and thrombocytosis. We conducted an analysis of the data from 312 patients with head and neck squamous cell carcinoma of various stages and locations. Preoperative platelet counts were analysed; elevated platelet count was defined as 300 G/l or higher. The influence of platelet count on survival was calculated with the Kaplan-Meier method as well as with multivariate Cox regression. In patients with excessive thrombocytosis, survival was significantly worse (overall survival: p = 0.007, disease-free survival: p = 0.192). This association remained significant even after adjusting the multivariate analysis for age, gender as well as tumour stage, grade, location, red and white blood cell count (overall survival: p = 0.027). The magnitude of thrombocytosis differed among tumours of different anatomical locations (hypopharynx: 43.6%, sub- and supraglottis: 35.8%, oral cavity: 35.7%, vocal cord: 22.5%, oropharynx: 19%, multiple: 50%), but this did not affect survival significantly (p = 0.603). Elevated platelet count may be related to a worse prognosis in head and neck squamous cell carcinoma patients. The impact of thrombocytosis does not vary with the anatomical location of the tumour. Orv Hetil. 2021; 162(17): 676-682.