Clinicopathological significance of preoperative thrombocytosis in patients with epithelial ovarian cancer
Keywords:Epithelial ovarian cancer, Thrombocytosis, CA-125
Background: Reactive thrombocytosis is reported in a variety of solid tumors. A few studies have documented preoperative thrombocytosis in ovarian cancer.
Methods: This was a cross-sectional study conducted in the Department of Gynaecological Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, during January to December 2019. A total of 94 patients with epithelial ovarian cancer between 18-70 years of age who underwent primary surgical treatment were included in this study. Chi-square tests were done to see the significance of differences between the two groups where p<0.05 considered as the level of significance with 95% CI.
Results: The mean age was 45.39±13.23 years in the thrombocytosis and 48.98±15.46 years in without thrombocytosis group with a range of 18 to 70 years (p=0.231). The difference in education and occupation were statistically significant (p<0.05) between the two groups. The mean Hb% was 10.02±1.47 (gm/dl) in thrombocytosis and 11.15±1.52 (gm/dl) without thrombocytosis group. The difference was statistically significant (p<0.001) between two groups. The study showed that 30 (75.0%) patient’s serum CA-125 was >500 in the thrombocytosis group and 9 (16.7%) in the without thrombocytosis group (p=0,001), OR=15.0, 95.0% CI=4.92 to 47.72, p=0.001. Optimal cytoreduction between two groups were observed statistically significant (p=0.004), OR=3.49, 95.0% CI=1.33 to 9.28. The difference of grade of tumor observed statistically significant between the groups (p=0.022). The 11 (27.5%) patients had lymph node metastasis in thrombocytosis group and 6 (11.1%) in without thrombocytosis, OR=3.03, 95.0% CI=0.91 to 10.48, p=0.022. The OR of developing lymph node metastasis was 3.03 times higher in the thrombocytosis group.
Conclusions: Thrombocytosis was commonly detected in preoperative evaluation of women diagnosed with epithelial ovarian cancer. Anemia, higher serum CA-125 level >500, sub-optimal cytoreduction, advanced stage disease, higher grade tumor, and lymphnode metastasis were significantly more frequent in patients with thrombocytosis.
Doherty JA, Peres LC, Wang C, Way GP, Greene CS, Schildkraut JM. Challenges and opportunities in studying the epidemiology of ovarian cancer subtypes. Curr Epidemiol Rep. 2017;4(3):211-20.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7-30.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics. 2020;2.
Cozzi GD, Samuel JM, Fromal JT, Keene S, Crispens MA, Khabele D, et al. Thresholds and timing of pre-operative thrombocytosis and ovarian cancer survival: analysis of laboratory measures from electronic medical records. BMC Cancer. 2016;16(1):612.
Berchuck A, Havrilesky LJ, Kauff ND. Is There a Role for Ovarian Cancer Screening in High-Risk Women? 2017;35(1):1384-6.
Kim SJ, Rosen B, Fan I, Ivanova A, McLaughlin JR, Risch H et al. Epidemiologic factors that predict long-term survival following a diagnosis of epithelial ovarian cancer. Brit J Cancer. 2017;116(7):964.
Gungor T, Kanat-Pektas M, Sucak A, Mollamahmutoglu L. The role of thrombocytosis in prognostic evaluation of epithelial ovarian tumors. Arch Gynecol Obstetr. 2009;279(1):53-6.
Ikeda M, Furukawa H, Imamura H, Shimizu J, Ishida H, Masutani S, et al. Poor prognosis associated with thrombocytosis in patients with gastric cancer. Ann Surgical Oncol. 2009;9(3):287-91.
Chadha AS, Kocak-Uzel E, Das P, Minsky BD, Delclos ME, Mahmood U, et al. Paraneoplastic thrombocytosis independently predicts poor prognosis in patients with locally advanced pancreatic cancer. Acta Oncologica. 2015;54(7):971-8.
Symbas NP, Townsend MF, El‐Galley R, Keane TE, Graham SD, et al. Poor prognosis associated with thrombocytosis in patients with renal cell carcinoma. BJU Int. 2000;86(3):203-7.
Heng S, Benjapibal M. Preoperative thrombocytosis and poor prognostic factors in endometrial cancer. Asian Pac J Cancer Prev. 2014;15(23):10231-6.
Helfer LR. World music on a US stage: a Berne/TRIPS and economic analysis of the fairness in Music Licensing Act. BUL Rev. 2000;80:93.
Hernandez E, Lavine M, Dunton CJ, Gracely E, Parker J. Poor prognosis associated with thrombocytosis in patients with cervical cancer. Cancer. 1992;69(12):2975-7.
Bozkurt N, Yuce K, Basaran M, Kose F, Ayhan A. Correlation of platelet count with second-look laparotomy results and disease progression in patients with advanced epithelial ovarian cancer. Obstetr Gynecol. 2004;103(1):82-5.
Allensworth SK, Langstraat CL, Martin JR, Lemens MA, McGree ME, Weaver AL, et al. Evaluating the prognostic significance of preoperative thrombocytosis in epithelial ovarian cancer. Gynecol Oncol. 2013;130(3):499-504.
Kemal Y, Demirağ G, Ekiz K, Yücel I. Mean platelet volume could be a useful biomarker for monitoring epithelial ovarian cancer. J Obstetr Gynaecol. 2014;34(6):515-8.
Digklia A, Voutsadakis IA. Thrombocytosis as a prognostic marker in stage III and IV serous ovarian cancer. Obstetr Gynecol Sci. 2014;57(6):457-63.
Cho MS, Bottsford-Miller J, Vasquez HG, Stone R, Zand B, Kroll MH et al. Platelets increase the proliferation of ovarian cancer cells. Blood. 2012;120(24):4869-72.
Stone RL, Nick AM, McNeish IA, Balkwill F, Han HD, Bottsford-Miller J, et al. Paraneoplastic thrombocytosis in ovarian cancer. N Eng J Med. 2012;366(7):610-8.
Torre LA, Trabert B, DeSantis CE, Miller KD, Samimi G, et al. Ovarian cancer statistics, 2018. CA: a cancer J Clin. 2018;68(4):284-96.
Chen Y, Zhang L, Liu WX, Liu XY. Prognostic significance of preoperative anemia, leukocytosis and thrombocytosis in chinese women with epithelial ovarian cancer. Asian Pac J Cancer Prev. 2015;16(3):933-9.
Pedersen LM, Milman N. Diagnostic significance of platelet count and other blood analyses in patients with lung cancer. Oncol Rep. 2003;10(1):213-6.
Naschitz JE, Yeshurun D, Eldar S, Lev LM. Diagnosis of cancer‐associated vascular disorders. Cancer: Interdisciplinary Int J Am Cancer Society. 1996;77(9):1759-67.
Hernandez E, Donohue KA, Anderson LL, Heller PB, Stehman FB. The significance of thrombocytosis in patients with locally advanced cervical carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2000;78(2):137-42.
Liang Z, Zhang H. Correlation between epithelial ovarian cancer and thrombocytosis. Chinese-German J Clin Oncol. 2009;8(4):225-8.
Ma X, Wang Y, Sheng H, Tian W, Qi Z, Teng F, Xue F. Prognostic significance of thrombocytosis, platelet parameters and aggregation rates in epithelial ovarian cancer. J Obstetr Gynaecol Res. 2014;40(1):178-83.
Crasta JA, Premlatha TS, Krishnan SM, Vallikad E, Rameshkumar K. Significance of preoperative thrombocytosis in epithelial ovarian cancer. Indian J Pathol Microbiol. 2010;53(1):54.
Zhou Q, Huang F, He Z, Zuo MZ. Clinicopathological and prognostic significance of platelet count in patients with ovarian cancer. Climacteric. 2018;21(1):60-8.
Ramu S, Sinha R. Significance of Thrombocytosis in Epithelial Ovarian Tumors. Int J Life Sci Scienti Res. 2017;3(6):1467-70.
Lee M, Kim SW, Nam EJ, Yim GW, Kim S, Kim YT. The impact of pretreatment thrombocytosis and persistent thrombocytosis after adjuvant chemotherapy in patients with advanced epithelial ovarian cancer. Gynecol Oncol. 2011;122(2):238-41.
Li AJ, Madden AC, Cass I, Leuchter RS, Lagasse LD, Karlan BY. The prognostic significance of thrombocytosis in epithelial ovarian carcinoma. Gynecol Oncol. 2004;92(1):211-4.
Slabuszewska-Jozwiak A, Dmoch-Gajzlerska E, Kozakiewicz B, Jakiel G. The prognostic significance of thrombocytosis in ovarian cancer. Ann Agricul Environ Med. 2015;22(4).