Takahashi Ryoko, Mabuchi Seiji, Kuroda Hiromasa, Kozasa Katsumi, Yokoi Eriko, Matsumoto Yuri, Kimura Tadashi
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
Int J Gynecol Cancer. 2017 Sep;27(7):1399-1407. doi: 10.1097/IGC.0000000000001019.
The aim of this study was to investigate the prognostic significance of a pretreatment thrombocytosis and its association with neutrophilia in patients with surgically treated endometrial cancer.
The baseline characteristics and outcome data of 508 patients with surgically treated endometrial cancer between January 2000 and December 2010 were collected and retrospectively reviewed. The patients were separated into 4 groups according to their platelet counts and the neutrophil counts, and the progression-free and overall survival rates of the 4 groups were compared. A Cox proportional hazards regression model was used to explore the independent prognostic factors.
Pretreatment thrombocytosis was found to be associated with advanced stage (P = 0.0186), nonendometrioid histology (P = 0.0139), a deeper myometrial invasion (P = 0.0103), lymphovascular space involvement (P = 0.0404), cervical involvement (P = 0.004), positive peritoneal cytology (P = 0.0198), lymph node metastasis (P = 0.0301), and more frequent treatment failure (P = 0.0006). Multivariate analysis demonstrated that an older age (hazard ratio [HR], 2.54; 95% confidence interval [CI], 1.46-4.51; P = 0.0009), advanced clinical stage (HR, 5.27; 95% CI, 2.94-9.86; P < 0.0001), lymphovascular space involvement (HR, 3.37; 95% CI, 1.74-7.07; P = 0.0002), and pretreatment thrombocytosis (HR, 4.99; 95% CI, 2.47-9.39; P < 0.0001) were significant predictors of survival. When examined according to clinical stage, pretreatment thrombocytosis was prognostically significant only in patients with stage III-IV disease. The neutrophil count in patients who display thrombocytosis was significantly greater than that observed in patients without thrombocytosis (median, 6702 vs 4406/μL; P < 0.0001). Moreover, patients who displayed both thrombocytosis and neutrophilia had significantly shorter survival than that in those with either thrombocytosis or neutrophilia alone.
Presence of thrombocytosis at the time of the initial diagnosis is an independent predictor of shorter survival in patients with advanced-stage (stages III-IV) endometrial cancer. Moreover, pretreatment thrombocytosis and concurrent neutrophilia are an independent predictor of shorter survival regardless of clinical stage.
本研究旨在探讨术前血小板增多症的预后意义及其与接受手术治疗的子宫内膜癌患者中性粒细胞增多的关系。
收集并回顾性分析2000年1月至2010年12月期间508例接受手术治疗的子宫内膜癌患者的基线特征和结局数据。根据患者的血小板计数和中性粒细胞计数将其分为4组，比较4组的无进展生存率和总生存率。采用Cox比例风险回归模型探讨独立预后因素。
发现术前血小板增多症与晚期（P = 0.0186）、非子宫内膜样组织学（P = 0.0139）、更深的肌层浸润（P = 0.0103）、淋巴管间隙受累（P = 0.0404）、宫颈受累（P = 0.004）、阳性腹膜细胞学（P = 0.0198）、淋巴结转移（P = 0.0301）及更频繁的治疗失败（P = 0.0006）相关。多因素分析表明，年龄较大（风险比[HR]，2.54；95%置信区间[CI]，1.46 - 4.51；P = 0.0009）、临床晚期（HR，5.27；95% CI，2.94 - 9.86；P < 0.0001）、淋巴管间隙受累（HR，3.37；95% CI，1.74 - 7.07；P = 0.0002）及术前血小板增多症（HR，4.99；95% CI，2.47 - 9.39；P < 0.0001）是生存的显著预测因素。根据临床分期进行检查时，术前血小板增多症仅在III - IV期疾病患者中具有预后意义。血小板增多症患者的中性粒细胞计数显著高于无血小板增多症患者（中位数，6702对4,406/μL；P < 0.0001）。此外，同时出现血小板增多症和中性粒细胞增多症的患者的生存期明显短于仅出现血小板增多症或中性粒细胞增多症的患者。
初始诊断时存在血小板增多症是晚期（III - IV期）子宫内膜癌患者生存期较短的独立预测因素。此外，无论临床分期如何，术前血小板增多症和同时存在的中性粒细胞增多症是生存期较短的独立预测因素。
