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Evaluating the prognostic significance of preoperative thrombocytosis in epithelial ovarian cancer.

ABSTRACT: OBJECTIVE:Preoperative thrombocytosis has been implicated as a negative prognostic marker for epithelial ovarian cancer (EOC). We assessed whether thrombocytosis is an independent risk factor for EOC recurrence and death. METHODS:Perioperative patient characteristics and process-of-care variables (National Surgical Quality Improvement Program (NSQIP)-defined) were retrospectively abstracted from 587 women who underwent EOC staging between 1/2/03-12/29/08. Thrombocytosis was defined as platelet count > 450 × 10(9)/L. Disease-free survival (DFS) and overall survival (OS) were determined using Kaplan-Meier methods. Associations were evaluated with Cox proportional hazards regression and hazard ratios (HR). RESULTS:The incidence of preoperative thrombocytosis was 22.3%. DFS was 70.8% and 36.0% at 1 and 3 years. OS was 83.3% and 54.3% at 1 and 3 years. Ascites, lower hemoglobin, advanced disease, and receipt of perioperative packed red blood cell transfusion were independently associated with thrombocytosis. Older age and the presence of coronary artery disease were associated with lower likelihood of thrombocytosis. Overall, thrombocytosis was an independent predictor of increased risk of recurrence. Among early stage (I/II) cases, there was a 5-fold increase in the risk of death and nearly 8-fold risk of disease recurrence independently associated with thrombocytosis. CONCLUSION:Preoperative thrombocytosis portends worse DFS in EOC. In early stage disease, thrombocytosis is a potent predictor of worse DFS and OS and further assessment of the impact of circulating platelet-derived factors on EOC survival is warranted. Thrombocytosis is also associated with extensive initial disease burden, measurable residual disease, and postoperative sequelae. Preoperative platelet levels may have value in primary cytoreduction counseling.

SUBMITTER: Allensworth SK

PROVIDER: S-EPMC3748213 | biostudies-literature | 2013 Sep

REPOSITORIES: biostudies-literature

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Evaluating the prognostic significance of preoperative thrombocytosis in epithelial ovarian cancer.

Allensworth S K SK Langstraat C L CL Martin J R JR Lemens M A MA McGree M E ME Weaver A L AL Dowdy S C SC Podratz K C KC Bakkum-Gamez J N JN

Gynecologic oncology 20130605 3

<h4>Objective</h4>Preoperative thrombocytosis has been implicated as a negative prognostic marker for epithelial ovarian cancer (EOC). We assessed whether thrombocytosis is an independent risk factor for EOC recurrence and death.<h4>Methods</h4>Perioperative patient characteristics and process-of-care variables (National Surgical Quality Improvement Program (NSQIP)-defined) were retrospectively abstracted from 587 women who underwent EOC staging between 1/2/03-12/29/08. Thrombocytosis was define ...[more]

PMID: 23747328

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Project description:BACKGROUND:High expression of the polymeric immunoglobulin receptor (PIGR) has previously been associated with a favourable prognosis in a few cancer forms, but its expression and relationship with clinical outcome in epithelial ovarian cancer (EOC) has not yet been reported. The aim of this study was therefore to examine the clinicopathological correlates and prognostic significance of PIGR expression in EOC. METHODS:After an initial screening in the Human Protein Atlas portal, a validated antibody was selected for extended analysis of immunohistochemical PIGR expression in tissue microarrays with tumours from 154 incident cases of EOC from two pooled prospective population-based cohorts. Subsets of corresponding benign-appearing fallopian tubes (n?=?38) and omental metastases (n?=?33) were also analysed. Kaplan-Meier analysis and Cox regression analysis were applied to examine the impact of PIGR expression on overall survival (OS) and ovarian cancer-specific survival (OCSS). RESULTS:PIGR expression was significantly higher in fallopian tubes compared to primary tumours and metastases (p?<?0.001) and lower in carcinoma of the serous subtype compared to other carcinomas (p?<?0.001). PIGR expression was significantly associated with lower grade (p?=?0.001), mucinous histological subtype (p?=?0.002), positive progesterone receptor expression (p?=?0.009) and negative or low Ki-67 expression (p?=?0.003). Kaplan-Meier analysis revealed a significantly improved OS (p?=?0.013) and OCSS (p?=?0.009) for patients with tumours displaying high expression of PIGR. These associations were confirmed in unadjusted Cox regression analysis (HR?=?0.48; 95% CI 0.26-0.87; p?=?0.015 for OS and HR?=?0.43, 95% CI 0.22-0.82; p?=?0.011 for OCSS) but did not remain significant after adjustment for age, grade and clinical stage. CONCLUSIONS:This study provides a first demonstration of PIGR expression in human fallopian tubes, primary EOC tumours and metastases. High tumour-specific expression of PIGR was found to be associated with a favourable prognosis in unadjusted, but not in adjusted, analysis. These findings are novel and merit further investigation.

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Evaluating the prognostic significance of preoperative thrombocytosis in epithelial ovarian cancer.

Publications

Evaluating the prognostic significance of preoperative thrombocytosis in epithelial ovarian cancer.

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