Is thrombocytosis a valid indicator of advanced stage and high mortality of gynecological cancer?

TY - JOUR

T1 - Is thrombocytosis a valid indicator of advanced stage and high mortality of gynecological cancer?

AU - Andersen, Christen Bertel L

AU - Eskelund, Christian W.

AU - Siersma, Volkert Dirk

AU - Felding, Peter

AU - Lind, Bent

AU - Palmblad, Jan

AU - Bjerrum, Ole Weis

AU - Friis, Søren

AU - Hasselbalch, Hans C.

AU - Olivarius, Niels de Fine

PY - 2015/11

Y1 - 2015/11

N2 - Objective: Thrombocytosis has been associated with higher stage and mortality of cancer, however, the evidence is conflicting. We examined the stage distribution and prognosis of gynecologic cancer according to levels of prediagnostic platelet count. Methods: In a primary care resource with blood cell counts from more than 500,000 individuals, we identified 581 women with a primary diagnosis of gynecological cancer. We divided the pre-diagnostic mean platelet count derived from the 3-year period prior to cancer diagnosis into three categories of thrombocytosis (no, 150–400 × 109 /L; mild, N400–550 × 109 /L; severe, N550 × 109 /L). Logistic regression models were used to calculate odds ratios (ORs) for the association of prediagnostic platelet counts with stage at diagnosis. Subsequently, we estimated hazard ratios (HRs) for all-cause or gynecological cancer-specific mortality by level of thrombocytosis using Cox proportional hazard regression models. Results: Patients with non-localized disease had higher levels of prediagnostic platelet count [mild thrombocytosis: OR, 2.36 (95% CI, 1.33–4.19); severe thrombocytosis: 4.54 (95% CI, 1.55–13.3); compared with no prediagnostic thrombocytosis]. The median overall survival was 1.04 years among patients with severe prediagnostic thrombocytosis and 3.25 years among those with mild thrombocytosis, P b 0.0001. When adjusting for stage at diagnosis, elevated all-cause mortality remained with both mild (HR = 1.51; 95% CI, 1.08–2.12) and severe (HR = 3.15; 95% CI 1.95-5.08) prediagnostic thrombocytosis. Similar associations were found for cancer-specific mortality. Conclusions: Prediagnostic thrombocytosis was associated with advanced stage of gynecological cancer at diagnosis and increased all-cause and cancer-specific mortality. The platelet count may have an important role in diagnosis and post-diagnostic control of gynecological cancer.

AB - Objective: Thrombocytosis has been associated with higher stage and mortality of cancer, however, the evidence is conflicting. We examined the stage distribution and prognosis of gynecologic cancer according to levels of prediagnostic platelet count. Methods: In a primary care resource with blood cell counts from more than 500,000 individuals, we identified 581 women with a primary diagnosis of gynecological cancer. We divided the pre-diagnostic mean platelet count derived from the 3-year period prior to cancer diagnosis into three categories of thrombocytosis (no, 150–400 × 109 /L; mild, N400–550 × 109 /L; severe, N550 × 109 /L). Logistic regression models were used to calculate odds ratios (ORs) for the association of prediagnostic platelet counts with stage at diagnosis. Subsequently, we estimated hazard ratios (HRs) for all-cause or gynecological cancer-specific mortality by level of thrombocytosis using Cox proportional hazard regression models. Results: Patients with non-localized disease had higher levels of prediagnostic platelet count [mild thrombocytosis: OR, 2.36 (95% CI, 1.33–4.19); severe thrombocytosis: 4.54 (95% CI, 1.55–13.3); compared with no prediagnostic thrombocytosis]. The median overall survival was 1.04 years among patients with severe prediagnostic thrombocytosis and 3.25 years among those with mild thrombocytosis, P b 0.0001. When adjusting for stage at diagnosis, elevated all-cause mortality remained with both mild (HR = 1.51; 95% CI, 1.08–2.12) and severe (HR = 3.15; 95% CI 1.95-5.08) prediagnostic thrombocytosis. Similar associations were found for cancer-specific mortality. Conclusions: Prediagnostic thrombocytosis was associated with advanced stage of gynecological cancer at diagnosis and increased all-cause and cancer-specific mortality. The platelet count may have an important role in diagnosis and post-diagnostic control of gynecological cancer.

U2 - 10.1016/j.ygyno.2015.09.017

DO - 10.1016/j.ygyno.2015.09.017

M3 - Journal article

C2 - 26407478

SN - 0090-8258

VL - 139

SP - 312

EP - 318

JO - Gynecologic Oncology

JF - Gynecologic Oncology

IS - 2

ER -