Thrombocytosis at secondary cytoreduction for recurrent ovarian cancer predicts suboptimal resection and poor survival
Thrombocytosis at secondary cytoreduction for recurrent ovarian cancer predicts suboptimal resection and poor survival
复制标题
DOI：
10.1016/j.ygyno.2014.01.003
复制
发表时间：
2014-03-01
影响因子：
4.7
通讯作者：
Li, Andrew J.
中科院分区：
文献类型：
--
作者：
Cohen, Joshua G.;Arthur-Quan Tran;Li, Andrew J.
目标。越来越多的证据支持血小板增多症在促进上皮性卵巢癌生物学中的作用。然而，研究仅将最初细胞减少术时的术前血小板计数与临床结果联系起来。在这里，我们试图确定二次细胞减少术(SCS)时血小板计数升高对复发疾病的影响。根据IRB批准的方案，我们确定了107名在1997年1月至2012年6月期间接受SCS的浸润性上皮性卵巢癌患者。我们回顾了这个回顾性队列的临床、实验室和病理记录。数据分析采用卡方检验、Fisher‘s精确检验、Cox比例风险检验和Kaplan-Meier检验。我们将血小板增多症定义为血小板计数>；=350x10(9)/L，并将SCS的最佳切除定义为显微残留病。107例复发卵巢癌患者中有13例(12%)在SCS前有血小板增多。SCS术前血小板增多与未能进行最佳切除有关(p=0.0001)。与血小板计数正常的患者(46个月，p=0.004)相比，术前有血小板增多的患者总体生存时间更短(33个月)。在多变量分析中，只有术前血小板计数作为独立的预后因素(p=0.025)在控制了SCS的年龄(p=0.9)、初次治疗的无病间隔(p=0.06)和疾病的初始阶段(p=0.66)后仍具有显著意义。SCS时血小板计数升高与次优切除和缩短总生存期有关。这些数据提供了进一步的证据，支持血小板增多在侵袭性卵巢肿瘤生物学中的合理作用。(C)2014 Elsevier Inc.保留所有权利。
Objectives. A growing body of evidence supports a role for thrombocytosis in the promotion of epithelial ovarian cancer biology. However, studies have only linked preoperative platelet count at time of initial cytoreductive surgery to clinical outcome. Here, we sought to determine the impact of elevated platelet count at time of secondary cytoreductive surgery (SCS) for recurrent disease.Methods. Under an IRB-approved protocol, we identified 107 women with invasive epithelial ovarian cancer who underwent SCS between January 1997 and June 2012. We reviewed clinical, laboratory, and pathologic records from this retrospective cohort. The data was analyzed using the chi-squared, Fisher's exact, Cox proportional hazards, and Kaplan-Meier tests. We defined thrombocytosis as a platelet count >= 350 x 10(9)/L and optimal resection at SCS as microscopic residual disease.Results. Thirteen of 107 women (12%) with recurrent ovarian cancer had thrombocytosis prior to SCS. Preoperative thrombocytosis at SCS was associated with failure to undergo optimal resection (p = 0.0001). Women with preoperative thrombocytosis at time of SCS demonstrated shorter overall survival (33 months) compared to those with normal platelet counts (46 months, p = 0.004). On multivariate analysis, only preoperative platelet count retained significance as an independent prognostic factor (p = 0.025) after controlling for age at SCS (p = 0.90), disease free interval from primary treatment (0.06), and initial stage of disease (0.66).Conclusions. Elevated platelet count at time of SCS is associated with suboptimal resection and shortened overall survival. These data provide further evidence supporting a plausible role for thrombocytosis in aggressive ovarian tumor biology. (C) 2014 Elsevier Inc. All rights reserved.