Feng Zheng, Wen Hao, Bi Rui, Duan Yachen, Yang Wentao, Wu Xiaohua
Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Road, Shanghai, 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
BMC Cancer. 2016 Jan 27;16:43. doi: 10.1186/s12885-016-2070-2.
Over 20% of ovarian cancer patients have preoperative thrombocytosis or hyperfibrinogenemia. We aimed to demonstrate the clinical and prognostic significance of thrombocytosis and hyperfibrinogenemia in high-grade serous ovarian cancer (HGSC).
We retrospectively investigated HGSC patients who underwent primary staging or debulking surgery between April 2005 and June 2013 in our institution. None of these patients had received neoadjuvant chemotherapy. Data, including age, performance status, FIGO stage, serum CA125, platelet count, fibrinogen level, and surgical residual disease, were collected. Thrombocytosis was defined as a platelet count greater than 450 × 10(9)/L, and hyperfibrinogenemia was defined as a fibrinogen level higher than 4.00 g/L. Progression-free survival (PFS) and overall survival (OS) were analyzed with the Kaplan-Meier method and log-rank tests for univariate analyses. For the multivariate analyses, Cox regression analysis was used to evaluate the effects of the prognostic factors, which are expressed as hazard ratios (HRs).
A total of 875 consecutive HGSC patients were identified. The median follow-up time was 29 (1-115) months. The median (interquartile range, IQR) preoperative platelet count was 301 (235-383) × 10(9)/L, and 121 (13.8%) women had thrombocytosis. The median (IQR) preoperative fibrinogen level was 3.85 (3.19-4.45) g/L, and 332 (45.9%) of the patients had hyperfibrinogenemia. Both preoperative thrombocytosis and hyperfibrinogenemia were associated with an advanced FIGO stage (p = 0.008 and <0.001, respectively), an increased CA125 level (p = 0.004 and 0.001, respectively), more extensive ascites (p < 0.001 and <0.001, respectively), more extensive residual disease (p < 0.001 and <0.001, respectively) and chemosensitivity (p = 0.043 and <0.001, respectively). In the univariate analyses, hyperfibrinogenemia was associated with reduced PFS (p < 0.001) and OS (p < 0.001). However, thrombocytosis was not found to be a potential predictor of PFS (P = 0.098) or OS (p = 0.894). In the multivariate analyses, hyperfibrinogenemia was an independent predictor of OS (p = 0.014) but not PFS (p = 0.062).
Preoperative thrombocytosis and hyperfibrinogenemia reflected tumor burden to some extent and thus influenced treatment outcomes, and the fibrinogen level was found to be useful as a prognostic predictor in the HGSC patients.
超过20%的卵巢癌患者术前存在血小板增多症或高纤维蛋白原血症。我们旨在阐明血小板增多症和高纤维蛋白原血症在高级别浆液性卵巢癌（HGSC）中的临床及预后意义。
我们回顾性研究了2005年4月至2013年6月在我院接受初次分期或肿瘤细胞减灭术的HGSC患者。这些患者均未接受新辅助化疗。收集了包括年龄、体能状态、国际妇产科联盟（FIGO）分期、血清CA125、血小板计数、纤维蛋白原水平及手术残留病灶等数据。血小板增多症定义为血小板计数大于450×10⁹/L，高纤维蛋白原血症定义为纤维蛋白原水平高于4.00g/L。采用Kaplan-Meier法和对数秩检验进行无进展生存期（PFS）和总生存期（OS）的单因素分析。多因素分析采用Cox回归分析评估预后因素的影响，结果以风险比（HRs）表示。
共纳入875例连续的HGSC患者。中位随访时间为29（1 - 115）个月。术前血小板计数的中位数（四分位数间距，IQR）为301（235 - 3８3）×10⁹/L，121例（13.8%）女性存在血小板增多症。术前纤维蛋白原水平的中位数（IQR）为3.85（3.19 - 4.45）g/L，332例（45.9%）患者存在高纤维蛋白原血症。术前血小板增多症和高纤维蛋白原血症均与晚期FIGO分期相关（分别为p = 0.008和<0.001）、CA125水平升高相关（分别为p = 0.004和0.001）、腹水更广泛相关（分别为p < 0.001和<0.001）、残留病灶更广泛相关（分别为p < 0.001和<0.001）以及化疗敏感性相关（分别为p = 0.043和<0.001）。在单因素分析中，高纤维蛋白原血症与PFS降低相关（p < 0.001）及OS降低相关（p < 0.001）。然而，未发现血小板增多症是PFS（P = 0.098）或OS（p = 0.894）的潜在预测指标。在多因素分析中，高纤维蛋白原血症是OS的独立预测指标（p = 0.014）但不是PFS的独立预测指标（p = 0.062）。
术前血小板增多症和高纤维蛋白原血症在一定程度上反映了肿瘤负荷，从而影响治疗结果，并且发现纤维蛋白原水平可作为HGSC患者的预后预测指标。
