SUNY Downstate Medical Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brooklyn, NY, USA.
Int J Gynecol Cancer. 2009 Nov;19(8):1384-9. doi: 10.1111/IGC.0b013e3181a47d47.
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.
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 t 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.
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.
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.
血小板增多症存在于广泛的恶性肿瘤中，发病率为 10%至 57%。有几份报告记录了诊断时的血小板增多症作为预后不良的指标。我们的研究是第一个评估主要为非裔美国人和加勒比裔美国城市人群中术前血小板增多症及其与生存关系的研究。
我们回顾性地分析了在 SUNY Downstate Medical Center 接受子宫内膜癌治疗的 99 例连续患者的病历。77 例患者被认为符合研究条件，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、淋巴血管空间侵犯、肌层浸润深度、宫内肿瘤体积、术前凝血酶原时间、部分促凝血酶原时间、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、学生 t 检验、卡方检验和 Fisher 精确检验分析数据。使用 Kaplan-Meier 表、对数秩检验和 Cox 比例风险模型进行生存分析。双尾 P<0.05 被认为具有统计学意义。
77 例患者中有 14 例（18.2%）出现血小板增多症（血小板计数>400 x 10(9)/L）。患有晚期疾病（III-IV 期）的患者术前血小板计数明显较高（359 +/- 23.8 x 10(9)/L），与患有局限性疾病（I-II 期，283 +/- 14.3 x 10(9)/L，P=0.005）的患者相比。无术前血小板增多症的 III 和 IV 期患者的中位 PFS 为 15.0 +/- 4.8 个月（n=21），有血小板增多症的患者为 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。唯一保留独立预后意义的变量是分期（风险比，3.268；P=0.040）和术前血小板增多症（风险比，每 100 个血小板增加 1.714；P=0.030）。在局限性疾病患者中，术前血小板增多症与 OS 或 PFS 恶化无关。
我们的数据表明，高危市中心区 III 至 IV 期子宫内膜癌患者的术前血小板增多症是一个独立的预后指标。这是在主要为非裔美国人和加勒比裔美国人群中首次报道。需要进一步研究阐明恶性肿瘤中血小板增多症的机制。血小板增多症与侵袭性肿瘤行为的关联需要调查抗血小板治疗及其对结局的影响。
