Preoperative platelet count associates with survival and distant metastasis in surgically resected colorectal cancer patients.
Preoperative platelet count associates with survival and distant metastasis in surgically resected colorectal cancer patients.
复制标题
DOI：
10.1007/s12029-013-9491-9
复制
发表时间：
2013-09
影响因子：
1.6
通讯作者：
Yang, Hushan
中科院分区：
文献类型：
--
作者：
Wan, Shaogui;Lai, Yinzhi;Myers, Ronald E;Li, Bingshan;Hyslop, Terry;London, Jack;Chatterjee, Devjani;Palazzo, Juan P;Burkart, Ashlie L;Zhang, Kejin;Xing, Jinliang;Yang, Hushan
血小板与癌症转移和预后有关。目前还没有基于人群的研究报道术前血小板计数是否能直接预测结直肠癌（CRC）患者的转移复发。我们使用了一组1,513例手术切除的CRC患者，评估了术前血小板计数对总生存率、总复发率以及局部和远处转移复发的预测作用。临床血小板计数高的患者（≥400× 109/L）的患者生存率明显下降（风险比[HR]=1.66，95%置信区间[CI] 1.34-2.05，P=2.6×10−6，Plog秩= 1.1×10−11）和复发（HR=1.90，1.24-2.93，P=0.003，Plog秩=0.003）。血小板计数与复发的相关性仅在转移性患者中明显（HR=2.81，1.67-4.74，P=1.1×10−4，Plog秩=2.6×10−6），而在局部复发患者中不明显（HR=0.59，95% CI 0.21-1.68，P= 0.325，Plog秩=0.152）。通过bootstrap再验证对结果进行了内部验证（在98.6%的再验证时，P<0.01）。死亡患者血小板计数显著高于存活患者（P<0.0001），转移复发患者血小板计数显著高于局部复发患者（P= 0.004）和非复发患者（P<0.0001）。时间依赖性模型表明，与术前血小板计数升高相关的死亡和转移风险增加持续至术后5年。我们的数据表明，临床高水平的术前血小板是一个独立的预测CRC生存和转移。作为常规检测的全血细胞计数的重要组成部分，血小板计数可能是CRC预后的一个具有成本效益和非侵入性的标志物，也是预防转移复发的潜在干预目标。
Platelets have been implicated in cancer metastasis and prognosis. No population-based study has been reported as to whether preoperative platelet count directly predicts metastatic recurrence of colorectal cancer (CRC) patients. Using a well-characterized cohort of 1,513 surgically resected CRC patients, we assessed the predictive roles of preoperative platelet count in overall survival, overall recurrence, as well as locoregional and distant metastatic recurrences. Patients with clinically high platelet count (≥400× 109/L) measured within 1 month before surgery had a significantly unfavorable survival (hazard ratio [HR]=1.66, 95 % confidence interval [CI] 1.34–2.05, P=2.6×10−6, Plog rank= 1.1×10−11) and recurrence (HR=1.90, 1.24–2.93, P=0.003, Plog rank=0.003). The association of platelet count with recurrence was evident only in patients with metastatic (HR=2.81, 1.67–4.74, P=1.1×10−4, Plog rank =2.6×10−6) but not locoregional recurrence (HR=0.59, 95 % CI 0.21–1.68, P= 0.325, Plog rank=0.152). The findings were internally validated through bootstrap resampling (P<0.01 at 98.6 % of resampling). Consistently, platelet count was significantly higher in deceased than living patients (P<0.0001) and in patients with metastatic recurrence than locoregional (P= 0.004) or nonrecurrent patients (P<0.0001). Time-dependent modeling indicated that the increased risks for death and metastasis associated with elevated preoperative platelet counts persisted up to 5 years after surgery. Our data demonstrated that clinically high level of preoperative platelets was an independent predictor of CRC survival and metastasis. As an important component of the routinely tested complete blood count panel, platelet count may be a cost-effective and noninvasive marker for CRC prognosis and a potential intervention target to prevent metastatic recurrence.