Pedersen L M, Milman N
Dept of Pulmonary Medicine, Gentofte Hospital, University of Copenhagen, Denmark.
Eur Respir J. 1996 Sep;9(9):1826-30. doi: 10.1183/09031936.96.09091826.
In patients with malignancies, thrombocytosis has previously been related to disease stage, histological type, and survival. In the present study, the prevalence of thrombocytosis and the prognostic information provided by platelet counts were analysed in a large cohort of patients with primary lung cancer. At the time of diagnosis, pretreatment platelet counts were retrospectively recorded in 1,115 consecutive patients with histologically proven primary lung cancer. All patients were reviewed regarding histological type, tumour, node, metastasis (TNM) classification stage and survival. The prevalence of thrombocytosis in patients with lung cancer was compared with that in a series of 550 consecutive out-patients with benign lung disorders. In 269 surgically resected patients, postoperative platelet counts were recorded 1-3 months after resection of the tumour. In the follow-up period, thromboembolic episodes diagnosed either clinically or at autopsy were recorded. The overall prevalence of thrombocytosis (> 400 x 10(9) platelets.L-1) in the patients with lung cancer was 32%. The frequency of thrombocytosis was significantly higher compared with the control subjects (32 vs 6%; p < 0.0001). Platelet counts differed significantly among subgroups defined by the TNM classification, with the proportion of patients with > 400 x 10(9) platelets.L-1 greatest in the more advanced TNM stages (stage I and II 23% vs stage III and IV 37%; p < 0.0001). Patients with thrombocytosis had a significantly poorer survival than patients with normal platelet counts (p < 0.0001). In a multivariate survival analysis (Cox model), thrombocytosis continued to correlate strongly with poor survival even when adjusted for histological type, sex, age, and TNM stage (p < 0.001). In surgically resected patients, the frequency of preoperative and postoperative thrombocytosis differed significantly (23.0 vs 8.9%; p < 0.0001). Survival rate was significantly reduced in patients with preoperative thrombocytosis (p = 0.005). Thrombocytosis was not associated with an increased incidence of thromboembolism. In conclusion, thrombocytosis is an independent prognostic factor of survival in patients with primary lung cancer. We suggest that platelet counts should be included in future multivariate analyses of survival in patients with lung cancer.
在恶性肿瘤患者中，血小板增多症先前已被认为与疾病分期、组织学类型及生存率有关。在本研究中，我们分析了一大群原发性肺癌患者中血小板增多症的患病率以及血小板计数所提供的预后信息。在诊断时，对1115例经组织学证实为原发性肺癌的连续患者的治疗前血小板计数进行了回顾性记录。对所有患者的组织学类型、肿瘤、淋巴结、转移（TNM）分类分期及生存率进行了评估。将肺癌患者中血小板增多症的患病率与550例连续的良性肺部疾病门诊患者进行了比较。在269例接受手术切除的患者中，记录了肿瘤切除术后1 - 3个月的血小板计数。在随访期间，记录了临床诊断或尸检诊断的血栓栓塞事件。肺癌患者中血小板增多症（> 400×10⁹/L血小板）的总体患病率为32%。与对照组相比，血小板增多症的发生率显著更高（32%对6%；p < 0.0001）。根据TNM分类定义的亚组之间血小板计数差异显著，TNM分期越晚，血小板计数> 400×10⁹/L的患者比例越高（I期和II期为23%，III期和IV期为37%；p < 0.0001）。血小板增多症患者的生存率显著低于血小板计数正常的患者（p < 0.0001）。在多变量生存分析（Cox模型）中，即使在对组织学类型、性别、年龄和TNM分期进行校正后，血小板增多症仍与较差的生存率密切相关（p < 0.001）。在接受手术切除的患者中，术前和术后血小板增多症的发生率差异显著（23.0%对8.9%；p < 0.0001）。术前血小板增多症患者的生存率显著降低（p = 0.005）。血小板增多症与血栓栓塞发生率的增加无关。总之，血小板增多症是原发性肺癌患者生存的独立预后因素。我们建议在未来肺癌患者生存的多变量分析中应纳入血小板计数。
