School of Medicine, Ninewells Hospital & Medical School, University of Dundee, Dundee, United Kingdom.
Division of Clinical and Molecular Medicine, Ninewells Hospital & Medical School, University of Dundee, Dundee, United Kingdom.
PLoS One. 2022 Apr 28;17(4):e0267124. doi: 10.1371/journal.pone.0267124. eCollection 2022.
Thrombocytosis is often an incidental finding in primary care with a range of causes. Despite evidence of a strong association between thrombocytosis and malignancy, guidelines for investigating thrombocytosis in the absence of red flag symptoms remain unclear. A novel automated system of laboratory analysis, intelligent Liver Function Testing (iLFT), launched in Tayside in 2018 and has identified a patient group with thrombocytosis and abnormal liver test (LFT) results. This study analysed the outcome of these patients and investigated the use of thrombocytosis combined with LFTs in predicting risk of cancer.
Between August 2018 and August 2020, 6792 patients underwent iLFT, with 246 found to have both thrombocytosis and at least one abnormal LFT. A random case-matched control group of 492 iLFT patients with normal platelet count and at least one abnormal LFT was created. 7.7% (95% CI 4.7-11.8%) of patients with thrombocytosis had cancer compared to 2.0% (1.0-3.7%) of controls. Patients <40 years or with pre-existing causes of thrombocytosis were then excluded. Subsequent analysis revealed a 10.8% (6.6-16.3%) incidence of cancer in thrombocytosis patients (n = 176) compared to 2.5% (1.2-4.6%, p = 0.00014) in patients with normal platelet count (PLT) (n = 398). When thrombocytosis is combined with elevated alkaline phosphatase (ALP), there is a positive predictive value (PPV) of 20% for cancer. These rules were subsequently applied to a validation cohort of 71,652 patients, of whom 458 had thrombocytosis and elevated ALP. There was a 30.6% cancer incidence, confirming the strong predictive value of the combined test of PLT and ALP.
These findings suggest a substantial increased risk of cancer in patients with thrombocytosis and raised ALP. This could be developed as an adjunct to current investigation algorithms, highlighting high-risk patients and prompting further investigation (such as computed tomography scans) where indicated.
血小板增多症在初级保健中常为偶然发现，其病因众多。尽管有大量证据表明血小板增多症与恶性肿瘤之间存在强烈关联，但在没有红色警报症状的情况下，针对血小板增多症的调查指南仍不明确。一种新型的实验室分析自动化系统，智能肝功能检测（iLFT）于 2018 年在泰赛德地区推出，并确定了一组伴有血小板增多症和异常肝功能检测（LFT）结果的患者群体。本研究分析了这些患者的结局，并研究了血小板增多症与 LFT 联合使用在预测癌症风险方面的作用。
在 2018 年 8 月至 2020 年 8 月期间，有 6792 名患者接受了 iLFT 检测，其中 246 名患者同时存在血小板增多症和至少一项异常 LFT。创建了一组随机病例匹配的 492 名 iLFT 患者对照组，这些患者血小板计数正常且至少有一项异常 LFT。与对照组（2.0%[95%CI 1.0-3.7%]）相比，血小板增多症患者中（n=246）有 7.7%（95%CI 4.7-11.8%）患有癌症。随后排除了<40 岁或存在血小板增多症的已知病因的患者。进一步分析显示，血小板增多症患者（n=176）的癌症发病率为 10.8%（6.6-16.3%），而血小板计数正常的患者（n=398）的癌症发病率为 2.5%（1.2-4.6%，p=0.00014）。当血小板增多症与碱性磷酸酶（ALP）升高相结合时，癌症的阳性预测值（PPV）为 20%。随后将这些规则应用于一个包含 71652 名患者的验证队列，其中 458 名患者血小板增多症和 ALP 升高。有 30.6%的癌症发生率，证实了 PLT 和 ALP 联合检测的强大预测价值。
这些发现表明，血小板增多症伴 ALP 升高的患者患癌症的风险显著增加。这可以作为当前调查算法的辅助手段，突出高危患者，并在需要时提示进一步检查（如计算机断层扫描）。
