Prognostic value of pretherapy platelet elevation in oropharyngeal cancer patients treated with chemoradiation
Prognostic value of pretherapy platelet elevation in oropharyngeal cancer patients treated with chemoradiation
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DOI：
10.1002/ijc.29870
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发表时间：
2016-03-01
影响因子：
6.4
通讯作者：
Fuller, Clifton D.
中科院分区：
文献类型：
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作者：
Shoultz-Henley, Sara;Garden, Adam S.;Fuller, Clifton D.
本研究的目的是评估接受同步放化疗的口咽癌患者中血小板增加与肿瘤学结局之间的潜在相关性。在2002年至2012年期间，共有433例接受调强放疗（IMRT）和同步化疗的口咽癌患者（OPC）纳入了经批准的IRB方案。提取全血细胞计数（CBC）数据。确定了治疗开始前末次静脉切开术的血小板和血红蛋白（PLT pre-chemoRT，Hgb（pre-chemoRT））。使用Dahlstrom-Sturgis标准对患者进行风险分层，并检测其与生存和疾病控制结局的相关性。化疗前PLT RT值>= 350 3 10（9）/L的患者局部区域控制（LRC）、无远处转移（FDM）和总生存（OS）降低（分别为p < 0.03、p < 0.04和p < 0.0001）。非血小板增多症患者的5年局部区域控制（LRC）和FDM分别为83%和85%，而高血小板患者的5年LRC和FDM分别为73%和74%。同样，血小板计数正常的患者的5年OS也更好（76 vs. 57%; p < 0.0001）。单变量参数模型的比较表明，PLTpre-chemoRT是更好的测试模型。多变量评估表明，包括治疗前血小板指数的模型的性能改善。贝叶斯信息标准分析，最佳预后模型，然后使用开发诺模图预测3，5和10年OS。总之，预处理血小板升高是一个很有前途的预后预测，并应做进一步的工作，以阐明抗血小板药物在修改OPC患者的风险效用。
The purpose of this study is to evaluate potential associations between increased platelets and oncologic outcomes in oropharyngeal cancer patients receiving concurrent chemoradiation. A total of 433 oropharyngeal cancer patients (OPC) treated with intensity-modulated radiation therapy (IMRT) with concurrent chemotherapy between 2002 and 2012 were included under an approved IRB protocol. Complete blood count (CBC) data were extracted. Platelet and hemoglobin from the last phlebotomy (PLTpre-chemoRT, Hgb(pre-chemoRT)) before start of treatment were identified. Patients were risk-stratified using Dahlstrom-Sturgis criteria and were tested for association with survival and disease-control outcomes. Locoregional control (LRC), freedom from distant metastasis (FDM) and overall survival (OS) were decreased (p < 0.03, p < 0.04 and p < 0.0001, respectively) for patients with PLTpre-chemoRT value of >= 350 3 10(9) /L. Actuarial 5-year locoregional control (LRC) and FDM were 83 and 85% for non-thrombocythemic patients while patient with high platelets had 5-year LRC and FDM of 73 and 74%, respectively. Likewise, 5-year OS was better for patients with normal platelet counts by comparison (76 vs. 57%; p < 0.0001). Comparison of univariate parametric models demonstrated that PLTpre-chemoRT was better among tested models. Multivariate assessment demonstrated improved performance of models which included pretherapy platelet indices. On Bayesian information criteria analysis, the optimal prognostic model was then used to develop nomograms predicting 3-, 5-and 10-year OS. In conclusion, pretreatment platelet elevation is a promising predictor of prognosis, and further work should be done to elucidate the utility of antiplatelets in modifying risk in OPC patients.