Prognostic Significance of Preoperative Thrombocytosis in Patients With Endometrial Carcinoma in an Inner-City Population
Prognostic Significance of Preoperative Thrombocytosis in Patients With Endometrial Carcinoma in an Inner-City Population
复制标题
DOI：
10.1111/igc.0b013e3181a47d47
复制
发表时间：
2009-11-01
影响因子：
4.8
通讯作者：
Abulafia, Ovadia
中科院分区：
文献类型：
--
作者：
Gorelick, Constantine;Andikyan, Vaagn;Abulafia, Ovadia
简介：血小板增多症存在于多种恶性肿瘤中，据报道发生率为 10% 至 57%。一些报告将诊断时的血小板增多症记录为不良预后指标。我们的研究是第一份评估术前血小板增多的作用及其与以非洲裔美国人和加勒比裔美国城市人口为主的生存关系的报告。材料和方法：我们回顾性审查了纽约州立大学下州医疗中心连续 99 名接受子宫内膜癌治疗的患者的图表。 77 名患者被认为符合该研究的条件，并从他们的病历中记录了以下临床病理特征：年龄、分期、分级、组织学亚型、是否存在淋巴管间隙侵犯、肌层侵犯深度、子宫内肿瘤体积、术前凝血酶原时间、活化部分凝血活酶时间、血小板计数、无进展生存期 （PFS）和总生存期（OS）。使用 Spearman 和 Pearson 相关性、Student I 检验、chi(2) 检验和 Fisher 精确检验对数据进行分析。使用 Kaplan-Meier 表、对数秩检验和 Cox 比例风险模型进行生存分析。 P < 0.05 的 2 尾值被认为是显着的。 结果：77 名患者中有 14 名（18.2%）表现出血小板增多（血小板计数>400 x 10(9)/L）。与局部疾病患者（I-II期，283 +/- 14.3 x 10(9)/L，P = 0.005）相比，晚期疾病（III-IV期）患者的术前平均血小板计数（359 +/- 23.8 x 10(9)/L）显着更高。术前无血小板增多症的 III 期和 IV 期患者的中位 PFS 为 15.0 +/- 4.8 个月 (n = 21)，术前血小板增多症患者的中位 PFS 为 3.0 +/- 1.4 个月 (n = 8，P = 0.032)。无血小板增多症患者的中位 OS 为 24.0 +/- 4.5 个月 (n = 21)，血小板增多症患者的中位 OS 为 7.0 +/- 3.8 个月 (n = 8，P = 0.015)。使用对数秩检验和Cox比例风险模型进行多变量分析。保留独立预后意义的唯一变量是分期（风险比，3.268；P = 0.040）和术前血小板增多症（风险比，每 100 个血小板 1.714；P = 0.030）。在局部疾病患者中，术前血小板增多与 OS 或 PFS 恶化无关。结论：我们的数据表明，患有 III 期至 IV 期子宫内膜癌的高危市中心患者术前血小板增多是一个独立的预后指标。这是针对以非裔美国人和加勒比裔美国人为主的人口的第一份此类报告。需要进一步的研究来阐明恶性肿瘤中血小板增多的机制。血小板增多症与侵袭性肿瘤行为之间的关联值得研究抗血小板治疗及其对结果的影响。
Introduction: Thrombocytosis is present in a wide range of malignancies, with a reported incidence of 10% to 57%. Several reports have documented thrombocytosis at the time of diagnosis as a poor prognostic indicator. Our study is the first report evaluating the role of preoperative thrombocytosis and its association with survival in a predominantly African American and Caribbean American urban population.Materials and Methods: We retrospectively reviewed the charts of 99 consecutive patients treated for endometrial carcinoma at SUNY Downstate Medical Center. Seventy-seven patients were deemed eligible for the study, and the following clinicopathologic characteristics were recorded from their medical records: age, stage, grade, histological subtype, presence of lymphovascular space invasion, depth of myometrial invasion, intrauterine tumor volume, preoperative prothrombin time, activated partial thromboplastin time, platelet count, progression-free survival (PFS), and overall survival (OS). The data were analyzed using Spearman and Pearson correlations, Student I test, chi(2) test, and Fisher exact test. Survival analysis was performed using Kaplan-Meier tables, log-rank test, and Cox proportional hazard model. The 2-tailed value of P < 0.05 was considered significant.Results: Fourteen (18.2%) of 77 patients exhibited thrombocytosis (platelet count, >400 x 10(9)/L). Patients with advanced disease (stages III-IV) had a significantly higher mean preoperative platelet count (359 +/- 23.8 x 10(9)/L) in comparison with patients with localized disease (stages I-II, 283 +/- 14.3 x 10(9)/L, P = 0.005). The median PFS among patients with stages III and IV without preoperative thrombocytosis was 15.0 +/- 4.8 months (n = 21) and with thrombocytosis was 3.0 +/- 1.4 months (n = 8, P = 0.032). The median OS in patients without thrombocytosis was 24.0 +/- 4.5 months (n = 21) and in patients with thrombocytosis was 7.0 +/- 3.8 months (n = 8, P = 0.015). Multivariate analysis was performed using log-rank test and Cox proportional hazard model. The only variables that retained independent prognostic significance were stage (hazards ratio, 3.268; P = 0.040) and preoperative thrombocytosis (hazards ratio, 1.714 per 100 platelets; P = 0.030). Among patients with localized disease, preoperative thrombocytosis was not associated with worsened OS or PFS.Conclusions: Our data indicate that preoperative thrombocytosis among high-risk inner-city patients with stages III to IV endometrial cancer is an independent prognostic indicator. This is the first such report in a predominantly African American and Caribbean American population. Further research is needed to elucidate the mechanisms of thrombocytosis in malignancy. Association of thrombocytosis and aggressive tumor behavior warrants investigation of antiplatelet therapy and its effect on outcome.