Edith Wolfson Medical Center, Holon, Israel
Rabin Medical Center, Petah Tikva, Israel.
Int J Gynecol Cancer. 2021 Nov;31(11):1437-1442. doi: 10.1136/ijgc-2021-002810.
Endometrial cancer prognosis is related to stage, histology, myometrial invasion, and lymphovascular space invasion. Several studies have examined the association between pretreatment thrombocytosis and patient outcomes with contrasting results regarding prognosis. Our aim was to evaluate the association of pretreatment platelet count with outcomes in endometrial cancer patients.
This is an Israeli Gynecologic Oncology Group multicenter retrospective cohort study of consecutive patients with endometrial cancer, who underwent surgery between January 2002 and December 2014. Patients were grouped as low risk (endometrioid G1-G2 and villoglandular) and high risk (endometrioid G3, uterine serous papillary carcinoma, clear cell carcinoma, and carcinosarcoma). Those with stage I disease were compared with stages II-IV. Disease stages were reviewed and updated to reflect International Federation of Gynecology and Obstetrics (FIGO) 2009 staging. All patients underwent pelvic washings for cytology and total abdominal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Pelvic lymph node assessment was performed in patients with tumors of moderate-high risk histology or deep myometrial invasion. Para-aortic sampling was performed at the surgeon's discretion. Patients were categorized by pretreatment platelet count into two groups: ≤400×10/L and >400×10/L (defined as thrombocytosis). Clinical and pathological features were compared using Student t-test, χ or Fisher's exact test. Survival measures were plotted with the Kaplan-Meier method and compared using the log-rank test. A Cox proportional hazards model was used for multivariable comparison of associations.
Of the 1482 patients included, most had stage I disease (961; 74.8%) and most had endometrioid histology (927; 64.1%). A total of 1392 patients (94%) had pretreatment platelet counts ≤400×10/L and 90 (6%) had pretreatment thrombocytosis. Patients with thrombocytosis had a significantly higher rate of high-grade malignancy, advanced stage, lymphovascular space invasion, low uterine segment involvement, and lymph node metastases. They also had shorter 5 year disease-free survival (65% vs 80%, p=0.003), disease-specific survival (63% vs 83%, p<0.05) and overall survival (59% vs 77%, p<0.05). On multivariate analysis, an elevated pretreatment thrombocyte count remained a significant independent predictor for disease-specific survival and overall survival.
Pretreatment thrombocytosis is an independent prognostic factor for decreased disease-specific survival and overall survival among patients with endometrial cancer, and can serve as a predictor of poor outcome.
子宫内膜癌的预后与分期、组织学、肌层浸润和脉管侵犯有关。有几项研究探讨了预处理血小板增多与患者预后的关系，但对于预后的结果却存在差异。我们的目的是评估预处理血小板计数与子宫内膜癌患者结局的关系。
这是以色列妇科肿瘤学组多中心回顾性队列研究，连续纳入 2002 年 1 月至 2014 年 12 月期间接受手术治疗的子宫内膜癌患者。患者分为低危组（子宫内膜样 G1-G2 和绒毛腺管状）和高危组（子宫内膜样 G3、子宫浆液性乳头状癌、透明细胞癌和癌肉瘤）。Ⅰ期疾病患者与Ⅱ-Ⅳ期疾病患者进行比较。疾病分期进行了回顾性评估，并根据国际妇产科联合会（FIGO）2009 分期进行了更新。所有患者均行盆腔细胞学冲洗术和全子宫或腹腔镜下双侧附件切除术。对于中高危组织学或深层肌层浸润的肿瘤患者，行盆腔淋巴结评估。根据外科医生的判断行腹主动脉旁取样。根据预处理血小板计数将患者分为两组：≤400×10/L 和＞400×10/L（定义为血小板增多症）。采用 Student t 检验、χ 检验或 Fisher 确切检验比较临床和病理特征。采用 Kaplan-Meier 法绘制生存曲线，并采用对数秩检验比较。采用 Cox 比例风险模型进行多变量比较。
在纳入的 1482 例患者中，大多数为Ⅰ期疾病（961 例，74.8%），大多数为子宫内膜样组织学（927 例，64.1%）。共有 1392 例（94%）患者的预处理血小板计数≤400×10/L，90 例（6%）患者有预处理血小板增多症。血小板增多症患者的高级别恶性肿瘤、晚期疾病、脉管侵犯、子宫下段受累和淋巴结转移的发生率明显更高。他们的 5 年无病生存率（65%比 80%，p=0.003）、疾病特异性生存率（63%比 83%，p<0.05）和总生存率（59%比 77%，p<0.05）也更短。多变量分析显示，预处理血小板计数升高仍然是疾病特异性生存率和总生存率的独立预后因素。
预处理血小板增多症是子宫内膜癌患者疾病特异性生存率和总生存率下降的独立预后因素，可作为不良预后的预测指标。
