Lower mean platelet volume predicts poor prognosis in renal cell carcinoma

From bench to bedside: Platelet biomimetic nanoparticles as a promising carriers for personalized drug delivery

In recent decades, there has been a burgeoning interest in cell membrane coating strategies as innovative approach for targeted delivery systems in biomedical applications. Platelet membrane-coated nanoparticles (PNPs), in particular, are gaining interest as a new route for targeted therapy due to their advantages over conventional drug therapies. Their stepwise approach blends the capabilities of the natural platelet membrane (PM) with the adaptable nature of manufactured nanomaterials, resulting in a synergistic combination that enhances drug delivery and enables the development of innovative therapeutics. In this context, we present an overview of the latest advancements in designing PNPs with various structures tailored for precise drug delivery. Initially, we describe the types, preparation methods, delivery mechanisms, and specific advantages of PNPs. Next, we focus on three critical applications of PNPs in diseases: vascular disease therapy, cancer treatment, and management of infectious diseases. This review presents our knowledge of PNPs, summarizes their advancements in targeted therapies and discusses the promising potential for clinical translation of PNPs.

Mean Platelet Volume in a Series of 315 Patients with Rheumatoid Arthritis: Relationship with Disease Characteristics, including Subclinical Atherosclerosis and Cardiovascular Comorbidity

Mean platelet volume (MPV) refers to the average platelet size in femtoliters. Increased or decreased MPV has been associated with several disorders, including inflammatory and cardiovascular diseases. In the present study, our objective was to analyze the relationship of MPV with disease activity in a large and well-characterized series of patients with rheumatoid arthritis (RA). This is a cross-sectional study that included 315 patients with RA and 208 controls matched by sex and age. Complete blood count, including MPV, was assessed. Multivariable analysis was performed to examine the relationship of MPV with RA disease characteristics, carotid atherosclerosis, and traditional cardiovascular factors, including a comprehensive profile of lipid molecules and insulin resistance or beta cell function indices. The multivariable analysis, which includes other hematological modifications produced by the disease and platelet values, showed that MPV levels were significantly lower in RA patients than in controls. Erythrocyte sedimentation rate and interleukin-6, but not C-reactive protein, were negatively correlated with MPV after adjustment for covariates. Similarly, disease activity and MPV had a significant and independent negative correlation. No relationships were found between MPV and cardiovascular risk factors, lipid profile or insulin resistance indices or subclinical atherosclerosis. In conclusion, patients with RA have lower levels of MPV than controls. MPV is negatively related to acute phase reactants and disease activity in RA.

The role of platelets in the regulation of tumor growth and metastasis: the mechanisms and targeted therapy

Platelets are a class of pluripotent cells that, in addition to hemostasis and maintaining vascular endothelial integrity, are also involved in tumor growth and distant metastasis. The tumor microenvironment is a complex and comprehensive system composed of tumor cells and their surrounding immune and inflammatory cells, tumor-related fibroblasts, nearby interstitial tissues, microvessels, and various cytokines and chemokines. As an important member of the tumor microenvironment, platelets can promote tumor invasion and metastasis through various mechanisms. Understanding the role of platelets in tumor metastasis is important for diagnosing the risk of metastasis and prolonging survival. In this study, we more fully elucidate the underlying mechanisms by which platelets promote tumor growth and metastasis by modulating processes, such as immune escape, angiogenesis, tumor cell homing, and tumor cell exudation, and further summarize the effects of platelet-tumor cell interactions in the tumor microenvironment and possible tumor treatment strategies based on platelet studies. Our summary will more comprehensively and clearly demonstrate the role of platelets in tumor metastasis, so as to help clinical judgment of the potential risk of metastasis in cancer patients, with a view to improving the prognosis of patients.

Relation of Mean Platelet Volume (MPV) with Cancer: A Systematic Review with a Focus on Disease Outcome on Twelve Types of Cancer

Inflammatory proteins activate platelets, which have been observed to be directly related to cancer progression and development. The aim of this systematic review is to investigate the possible association between Mean Platelet Volume (MPV) and cancer (diagnostic capacity of MPV, relation to survival, the severity of the disease, and metastasis). A literature review was performed in the online database PubMed and Google Scholar for the period of 2010–2022. In total, 83 studies including 21,034 participants with 12 different types of cancer (i.e., gastric cancer, colon cancer, esophageal squamous cell carcinoma, renal cancer, breast cancer, ovarian cancer, endometrial cancer, thyroid cancer, lung cancer, bladder cancer, gallbladder cancer, and multiple myeloma) were identified. The role of MPV has been extensively investigated in several types of cancer, such as gastric, colon, breast, and lung cancer, while few data exist for other types, such as renal, gallbladder cancer, and multiple myeloma. Most studies in gastric, breast, endometrium, thyroid, and lung cancer documented an elevated MPV in cancer patients. Data were less clear-cut for esophageal, ovarian, and colon cancer, while reduced MPV was observed in renal cell carcinoma and gallbladder cancer. Several studies on colon cancer (4 out of 6) and fewer on lung cancer (4 out of 10) indicated an unfavorable role of increased MPV regarding mortality. As far as other cancer types are concerned, fewer studies were conducted. MPV can be used as a potential biomarker in cancer diagnosis and could be a useful tool for the optimization of treatment strategies. Possible underlying mechanisms between cancer and MPV are discussed. However, further studies are needed to elucidate the exact role of MPV in cancer progression and metastasis.

Can the prognosis of individual patients with nasopharyngeal carcinoma be predicted using a routine blood test at admission?

BACKGROUND AND PURPOSE

We sought to determine the prognostic value of a pre-treatment peripheral blood signature and the peripheral blood signature-based nomogram for patients with non-metastatic nasopharyngeal carcinoma (NPC).

MATERIALS AND METHODS

We retrospectively collected 21 peripheral blood indicators from patients with NPC between 2004 and 2015. Data were randomly divided into a training and a validation set (ratio: 6:4). The peripheral blood signature was constructed based on candidate biomarkers using the least absolute shrinkage and selection operator Cox regression model. Multivariable logistic regression was applied to identify the independent risk factors of overall survival to build the nomogram. The predictive value of the peripheral blood nomogram was evaluated using time-dependent area under the curve, decision curve analysis, and calibration curve.

RESULTS

In total, 6668 patients were enrolled with 4000 and 2668 in the training and validation cohorts, respectively. Four peripheral blood indicators, (white blood cell count, lymphocyte percentage, haemoglobin, and mean platelet volume), were included to construct the peripheral blood signature. Patients were divided into low- and high-risk groups using an optimal cut-off value of - 1.71142. Patients in the high-risk group had significantly lower overall, distant metastasis-free, and progression-free survival than patients in the low-risk group in both cohorts (P < 0.05). We constructed and validated a peripheral blood signature-based nomogram in combination with five vital clinical characteristics, (age, sex, tumour stage, nodal stage, and pre-treatment Epstein-Barr virus DNA), which showed favourable performance.

CONCLUSION

Patients with NPC with different outcomes could be distinguished based on their peripheral blood signature score; the proposed peripheral blood signature-based nomogram offers individualised risk estimation.

Soluble klotho as an effective biomarker to characterize inflammatory states

BACKGROUND & AIMS

Soluble α-Klotho (s-Klotho) is a circulating protein with pleiotropic effects that mainly induce protective effects. Our study investigates the associations between s-Klotho and several established inflammatory biomarkers, with the aim of examining whether s-Klotho levels are representative of inflammatory states.

METHODS

A total of 11,128 eligible participants from NHANES 2007-2016 were included in our study. Levels of four inflammatory biomarkers, uric acid (UA), C-reactive protein (CRP), white blood cell (WBC) count, and mean platelet volume (MPV), were examined for their relationship with s-Klotho levels. Sub-analyses sorted the total population by gender and into four quartiles. Linear regression models were used to evaluate the strengths of associations.

RESULTS

All four inflammatory biomarkers were significantly associated with s-Klotho levels. UA, CRP, and WBC count showed an inverse association, while MPV showed a direct one. Of the four markers, UA was most strongly correlated with s-Klotho levels (β coefficient: -28.89 in unadjusted model, p<.001), and this relationship was stronger in women than in men (β coefficient of UA in men: -22.01, p<.001; in women: -31.54, p<.001). In addition, all four biomarkers manifested stronger associations with s-Klotho in higher quartiles, and the highest absolute values of β coefficients appeared in Q4 vs. Q1.

CONCLUSION

s-Klotho is significantly associated with well-recognized inflammatory biomarkers. A decrease in s-Klotho levels implies a general inflammatory status; therefore, s-Klotho serves as a potential biomarker that is inversely correlated with inflammatory conditions. Further applications in clinical practice will provide us with a better understanding of its role.Key messagesSoluble α-Klotho (s-Klotho) levels are significantly associated with the inflammatory markers uric acid, C-reactive protein, white blood cell count, and mean platelet volume.S-Klotho is involved in inflammatory processes and plays a protective role.S-Klotho may serve as an inverse indicator of inflammation.

Associations of Complete Blood Count Parameters with Disease-Free Survival in Right- and Left-Sided Colorectal Cancer Patients

Colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide. Some complete blood count (CBC) parameters are found to be associated with CRC prognosis. In this study, ninety-seven pretreated CRC patients were included, and the patients were divided into two groups: left-sided and right-sided, depending on the anatomical location of the tumor. Based on clinicopathologic features including tumor budding, disease stages, and tumor anatomical location, levels of CBC parameters were compared, and disease-free survivals (DFS) were determined. There were differences between patients with different tumor budding scores for only three parameters, including red cell distribution width (RDW), numbers of platelets, and mean platelet volume (MPV). Furthermore, numbers of WBCs, monocytes, and MPV in CRC patients with early disease stages were higher than those with advanced stages. However, levels of eosinophil in CRC patients with advanced stages were higher than those with early stages. Depending on the tumor anatomical location, we observed that numbers of red blood cells (RBCs), hemoglobin (Hgb), and hematocrit (Hct) in CRC patients with left-sided tumors were higher than those with right-sided tumors. We found that low levels of MPV were associated with shorter DFS. However, high levels of eosinophils were associated with shorter DFS in all CRC patients. When patients were divided based on the tumor anatomical location, higher levels of MPV, MCHC, and Hgb were associated with better DFS in the left-sided but not right-sided CRC patients. However, left-sided, but not right-sided, CRC patients with high levels of eosinophil and RDW had shorter DFS. Furthermore, right-sided, but not left-sided, CRC patients with high levels of platelets tended to have a shorter DFS. Our data show that MPV and eosinophils could serve as potential prognostic biomarkers in pre-treatment CRC patients, regardless of the tumor anatomical location. Additionally, lower levels of MPV, MCHC, and Hgb, and high levels of eosinophils and RDW could be negative predictive biomarkers in left-sided CRC patients.

Intratumoral Platelets: Harmful or Incidental Bystanders of the Tumor Microenvironment?

Simple Summary

The tumor microenvironment (TME) is the complex and heterogenous ecosystem of solid tumors known to influence their growth and their progression. Besides tumor cells, the TME comprises a variety of host-derived cell types, ranging from endothelial cells to fibroblasts and immune cells. Clinical and experimental data are converging to indicate that platelets, originally known for their fundamental hemostatic function, also participate in tumor development and shaping of the TME. Considering the abundance of antiplatelet drugs, understanding if and how platelets contribute to the TME may lead to new therapeutic tools for improved cancer prevention and treatments.

Abstract

The tumor microenvironment (TME) has gained considerable interest because of its decisive impact on cancer progression, response to treatment, and disease recurrence. The TME can favor the proliferation, dissemination, and immune evasion of cancer cells. Likewise, there is accumulating evidence that intratumoral platelets could favor the development and aggressiveness of solid tumors, notably by influencing tumor cell phenotype and shaping the vascular and immune TME components. Yet, in contrast to other tumor-associated cell types like macrophages and fibroblasts, platelets are still often overlooked as components of the TME. This might be due, in part, to a deficit in investigating and reporting the presence of platelets in the TME and its relationships with cancer characteristics. This review summarizes available evidence from clinical and animal studies supporting the notion that tumor-associated platelets are not incidental bystanders but instead integral and active components of the TME. A particular emphasis is given to the description of intratumoral platelets, as well as to the functional consequences and possible mechanisms of intratumoral platelet accumulation.

Preoperative Platelet Distribution Width Represents a Novel Prognostic Biomarker in Patients With Nonmetastatic Renal Cell Carcinoma: A Retrospective Clinical Analysis

Purpose

The study aimed to explore the prognostic value of platelet distribution width (PDW) in patients with nonmetastatic renal cell carcinoma (RCC).

Methods

We retrospective analyzed 706 patents with nonmetastatic RCC from January 2015 to December 2017. Clinicopathologic data and platelet indices were collected and analyzed by univariable and multivariable cox proportional hazard model. Progression-free survival (PFS) was analyzed using the Kaplan–Meier curve. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were performed to evaluate the improvement of predictive accuracy.

Results

Patients were divided into low PDW (N = 241, PDW ≤11.7%), intermediate PDW (N = 232, 11.7%< PDW ≤15.6%), and high PDW (N = 233, PDW >15.6%) groups according to the tertiles. Patients with low PDW were associated with more symptoms at presentation, larger tumor size, higher AJCC tumor stage, and more sarcomatoid differentiation. Besides, patients with low PDW had significantly shorter PFS compared to intermediate PDW and high PDW groups. On the multivariable model, AJCC tumor stage, nuclear grade, and PDW (either continuous or categorical variables) were independent factors correlated with PFS. The NRI and IDI showed adding PDW to SSIGN score improves its predictive accuracy related to 2-, 3-, and 4-year PFS.

Conclusions

Low PDW was related to advanced clinicopathologic features and worse prognosis in patients with nonmetastatic RCC. Thus, PDW could serve as a novel biomarker for risk stratification in these patients when used pre-or postoperatively.

Low Preoperative Mean Platelet Volume/Platelet Count Ratio Indicates Worse Prognosis in Non-Metastatic Renal Cell Carcinoma

Objectives: Multiple blood parameters are used to determine the prognosis of renal cell carcinoma (RCC). Mean platelet volume/platelet count (MPV/PC) ratio is related to disease progression in various cancers. Our study tried to evaluate the prognostic value of the MPV/PC ratio in RCC patients who underwent surgery. Methods: We retrospectively reviewed 89 patients who underwent radical or partial nephrectomy for RCC in a single institution. Baseline characteristics and MPV/PC ratios were analyzed. The optimal cut-off value of the MPV/PC ratio was determined by a receiver operating characteristic (ROC) curve, and our patients were divided into low and high MPV/PC ratio groups. The Kaplan–Meier survival curve and Cox proportional hazards model were applied for progression-free survival (PFS) and overall survival (OS) analyses. Harell’s C-index was used to compare the prognostic values of the MPV/PC ratio, MPV and PC. Results: Lower MPV/PC ratios were correlated with more advanced tumor stages and worse outcomes. The optimal cut-off value of the preoperative MPV/PC ratio was 0.034 (sensitivity 84.6%, specificity 56.6%). The Kaplan–Meier survival curve revealed that low MPV/PC ratios were associated with worse PFS (p = 0.007) and OS (p = 0.017). Multivariate analysis showed that low MPV/PC ratios were an independent unfavorable factor for PFS (p = 0.044) and OS (p = 0.015). Harell’s C-indexes showed that the prognostic value of the MPV/PC ratio was significantly better than MPV and PC (p < 0.001). Conclusion: Low MPV/PC ratios are an independent, unfavorable risk factor for disease progression and overall survival in patients undergoing surgery for RCC.

Platelets: The Emerging Clinical Diagnostics and Therapy Selection of Cancer Liquid Biopsies

Due to the inherent molecular heterogeneity of metastatic tumours and the dynamic evolution ability of tumour genomes, tumour tissues obtained through biopsy and other methods cannot capture all of the features of tumour genomes. A new diagnostic concept called “liquid biopsy” has received widespread attention in recent years. Liquid biopsy has changed the clinical practice of oncology and is widely used to guide targeted drug utilization, monitor disease progression and track drug resistance. The latest research subject in liquid biopsy is platelets. Platelets originate from multifunctional haematopoietic stem cells in the bone marrow haematopoietic system. They are small cells from the cytoplasm of bone marrow megakaryocytes. Their main physiological functions are to participate in the processes of physiological haemostasis and coagulation. Tumour cells transfer biomolecules (such as RNA) to platelets through direct contact and release of exosomes, which changes the platelet precursor RNA. Under the stimulation of tumour cells and the tumour microenvironment, platelet precursor mRNA is spliced into mature RNA and converted into functional protein to respond to external stimuli, forming tumour-educated platelets (TEPs). The detection of TEPs in the peripheral blood of patients is expected to be used in clinical tumour diagnosis. This emerging liquid biopsy method can replace and supplement the current tumour detection methods. Further research on the role of platelets in tumour diagnosis will help provide a novel theoretical basis for clinical tumour diagnosis.

Economical and easily detectable markers of digestive tumors: platelet parameters

Aim: This study aimed to evaluate the clinical values of platelet parameters in patients with digestive tumors. Patients & methods: A total of 974 people were classified into three groups: malignant group, patients with digestive malignant tumors; benign group, patients with benign tumors; and normal group: healthy individuals. Results: Compared with the benign and normal groups, the malignant group showed significantly increased platelet count (PLT) and plateletcrit (PCT) and significantly reduced mean platelet volume (MPV) and platelet-large cell rate (P-LCR, p < 0.001). Elevated PLT and PCT and reduced MPV and P-LCR indicated poor overall survival in patients with digestive tumors. Conclusion: PLT, PCT, MPV and P-LCR were proven to be predictive biomarkers for patients with digestive malignant tumors. Elevated PLT and PCT or decreased MPV and P-LCR indicated poor overall survival.

Prognostic value of platelet-associated biomarkers in rectal cancer patients received neoadjuvant chemoradiation: A retrospective study

PURPOSE

Platelet volume has been shown to prognostic value in patients with colorectal cancer. However, the changes of other platelet-associated biomarkers in rectal cancer patients, before and after the neoadjuvant chemoradiation therapy (NACRT), remain unclear. In this study, we investigated the prognostic value of platelet-associated biomarkers in rectal cancer patients with NACRT.

PATIENTS AND METHODS

A total of 75 patients with locally advanced (T3-4 or N+) rectal cancer (LARC) cancer were selected and followed up from the Affiliated Cancer Hospital of Zhengzhou University between June 2013 and September 2016. The data of platelet-associated biomarkers, including the platelet count, platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), mean platelet volume (MPV), and platelet distribution width (PDW) both pre- and post- NACRT, were collected. The associations between these platelet-associated biomarkers and the overall survival (OS), as well as disease-free survival (DFS) of patients, were analysed. Patients were divided into groups with high or low values of the platelet-associated biomarkers, and the outcomes were compared by using Cox regression and Kaplan-Meier analysis.

RESULTS

We found that pre-PLR (HR: 4.104; 95%CI: 1.411-11.421; P=0.009) and pre-LMR (HR: 0.384; 95%CI: 0.124-1.185; P=0.066) could predict the OS in LARC patients after NACRT by multivariate Cox regression analysis, a cut-off value of pre-PLR>7.02 and pre-LMR ≤7.10 could be used as independent prognostic factors for OS by Kaplan-Meier method. The pre-MPV value could be used as an independent prognostic factor for DFS by Kaplan-Meier analysis (P=0.037). Moreover, post-CEA was correlated with OS and DFS in LARC patients with NACRT.

CONCLUSION

In LARC patients with NACRT, the pre-PLR and pre-LMR are independent prognostic factors for OS, while pre-MPV has predictive value for DFS.

Diagnostic and prognostic role of mean platelet volume and mean platelet volume/platelet ratio in the most common soft tissue sarcomas

Objectives

This study aims to investigate the diagnostic and prognostic role of mean platelet volume (MPV) and MPV/platelet (PLT) ratio in the most common soft tissue sarcomas.

Patients and methods

We retrospectively investigated 131 patients (76 males, 55 females; mean age: 51.8±17.1; range, 18 to 87 years) with soft-tissue sarcomas between January 2011 and January 2019. Demographic features, MPV, PLT counts, mortality, and recurrence records of the patients were obtained from archives. A total of 165 healthy volunteers (101 males, 64 females; mean age 52.9±4.1; range, 18 to 60 years) who applied to the outpatient clinic in 2019 and had routine blood control without any additional disease formed the control group.

Results

A total of 55 patients were diagnosed with liposarcoma and 76 with pleomorphic sarcoma. Of the tumors, 77.1% were located in the lower limbs. Lesions were mostly localized on the thigh 48.8% (n=64). Recurrence occurred in 28.2% of the patients. A total of 25 (19.1%) patients were exitus. The mean follow-up period of the patients was 34.4±19.1 (range, 9 to 112) months. The mean PLT value of the patient group was significantly higher than the control group. The median MPV and MPV/PLT ratio were statistically significantly lower in the patient group than in the control group. The MPV and MPV/PLT ratio were not associated with mortality and recurrence.

Conclusion

As a result, MPV and MPV/PLT ratio can be used as a diagnostic support parameter in soft tissue sarcomas, but have no prognostic value.

Diagnostic and prognostic role of mean platelet volume and mean platelet volume/platelet ratio in patients with primary malignant bone tumor

Objectives

This study aims to investigate the diagnostic and prognostic role of mean platelet volume (MPV) and MPV/platelet (PLT) ratio in primary malignant bone tumors.

Patients and methods

We retrospectively investigated patients with primary malignant bone tumors between January 2010 and January 2019 and included 109 patients (69 males, 40 females; mean age: 41.9±17.9 years; range 15 to 86 years) in the study. A total of 107 healthy volunteers (61 males, 46 females; mean age: 47 years; range 19 to 61 years) who donated blood to the blood center of our hospital in 2019 formed the control group. Demographic features, MPV, PLT counts, mortality, and recurrence records of the patients were obtained from archives.

Results

Of the 109 patients, 11 were diagnosed with Ewing’s sarcoma, 52 with chondrosarcoma, and 46 with osteosarcoma. The tumor was located on the right in 56% of patients and on the lower extremity in 59.6% of patients. The recurrence rate was 41.3% in the patient group. Of the 109 patients, 17 (15.6%) resulted in exitus at follow-up. The mean PLT value of the patient group was significantly higher than the control group (289,440 vs. 247,299, p<0.001). The median MPV and MPV/PLT ratios were statistically significantly lower in the patient group than in the control group (8.3 vs. 10.5, p<0.001 and 0.032 vs. 0.043, p<0.001, respectively). The MPV, PLT count, and MPV/PLT ratio were not associated with mortality and recurrence. The cut-off value was determined as >9.25 fL for MPV (sensitivity=74%, specificity=85%, positive likelihood ratio=4.96, positive predictive value=83.4%, and negative predictive value=76.5).

Conclusion

Consequently, MPV and MPV/PLT ratios can be used as a diagnostic support parameter in primary malignant bone tumors, but have no prognostic value.

Prognostic and clinicopathological significance of pretreatment mean platelet volume in cancer: a meta-analysis

OBJECTIVE

Our study aimed to evaluate the prognostic and clinicopathological significance of pretreatment mean platelet volume (MPV) on cancer by using meta-analysis of published studies.

DESIGN

Meta-analysis.

DATA SOURCES

Relevant studies available before 22 December 2019 were identified by searching MEDLINE, EMBASE.

ELIGIBILITY CRITERIA

All published studies that assessed the prognostic and clinicopathological significance of pretreatment MPV on cancer were included.

DATA EXTRACTION AND SYNTHESIS

Studies were identified and extracted by two reviewers independently. The HR/OR and its 95% CIs of survival outcomes and clinicopathological parameters were calculated.

RESULTS

A total of 38 eligible studies (41 subsets) with 9894 patients with cancer were included in the final meta-analysis. MPV level was not significantly associated with both overall survival (HR 0.98, 95% CI 0.84 to 1.14) and disease-free survival (HR 1.22, 95% CI 0.86 to 1.73) of patients with cancer. Neither advanced nor mixed-stage tumour patients showed significant association between MPV and overall survival (HR 1.36, 95% CI 0.96 to 1.94, HR 0.90, 95% CI 0.74 to 1.09). However, high MPV had the strongest relationship with poor overall survival (HR 2.01; 95% CI 1.08 to 3.41) in gastric cancer, followed by pancreatic cancer (HR 1.54; 95% CI 1.31 to 1.82). Whereas in the subgroup using receiver operating characteristic curve method to define cut-off values, low MPV was significantly related to poor overall survival (HR 0.78, 95% CI 0.64 to 0.95). In addition, MPV had no significant association with age (OR 0.96, 95% CI 0.90 to 1.02), sex (OR 1.04, 95% CI 1.00 to 1.09), depth of cancer invasion (OR 0.90, 95% CI 0.77 to 1.04) and tumour stage (OR 0.91, 95% CI 0.78 to 1.07).

CONCLUSIONS

Pretreatment MPV level is of no clearly prognostic significance in cancers and no significant association with clinicopathological parameters of patients with cancers.

Mean Platelet Volume Has Prognostic Value in Chronic Lymphocytic Leukemia

PURPOSE

Mean platelet volume (MPV) is a readily accessible and commonly tested hematological indicator. Recent studies revealed a significant impact of MPV on the course and prognosis of many diseases, including some types of cancer, as well as on the incidence of atrial fibrillation and bleeding. The study aimed to perform a retrospective analysis of MPV in terms of time to first treatment (TTFT) and to determine its prognostic value in the group of patients with chronic lymphocytic leukemia (CLL). Moreover, the study includes a retrospective analysis of platelet parameters in patients treated with ibrutinib concerning bleeding and atrial fibrillation.

PATIENTS AND METHODS

The study included 523 patients with CLL, for 344 the most important cytogenetic aberrations were reported. The Mann-Whitney, Kruskal-Wallis, Kaplan-Meier, chi-squared, log‑rank tests and multivariate Cox proportional hazard regression model were used to analyze collected data.

RESULTS

The receiver operating characteristic curve analysis was performed to identify optimal cut-off value for MPV. The analysis of survival curves showed that in the group of patients with higher values of MPV TTFT was significantly longer than in the group with lower MPV (17.9 vs 36 months, p=0.0015, cut-off value for MPV= 10.4 fl). In multivariate Cox proportional hazard regression model low MPV, the presence of del11q and del13q provided independent prognostic value for TTFT (HR=0.69, 95%-CI, 0.5293 to 0.9081; p=0.0078; HR=1.76, 95%-CI, 1.3000 to 2.3882, p=0.0003, HR=0.74, 95%-Cl, 0.5674 to 0.9588, p=0.0229, respectively). In the group treated with ibrutinib, 59 patients had no significant correlation between MPV level and the incidence of therapy complications, although in the group of patients with low MPV there was a tendency for more frequent occurrence of atrial fibrillation (p=0.259).

CONCLUSION

Low MPV values are associated with unfavorable prognosis and might represent a novel, independent prognostic factor in CLL.

Blood platelet volume predicts treatment-specific outcomes of metastatic castration-resistant prostate cancer

BACKGROUND

In the present guidelines for the management of metastatic castration-resistant prostate cancer (mCRPC), it is unclear who benefits most from androgen receptor axis-targeted agents (ARATs) or docetaxel as the first-line treatment.

METHODS

We conducted a retrospective study to explore new treatment-specific biomarkers in mCRPC. A total of 211 patients with mCRPC who received either ARAT or docetaxel as first-line treatment were included. Patients were compared for radiographic progression and prostate-specific antigen (PSA) progression. Multivariable Cox regression models were used to assess the association between pretreatment biomarkers and risk of events. The statistical interaction between biomarkers and clinical outcomes was also evaluated.

RESULTS

Of all analyzed biomarkers, multivariable Cox regression models identified MPV [≤ median (9.7 fL)] as an independent prognostic factor of radiographic progression [hazard ratio (HR), 2.35; 95% confidence interval (CI), 1.15-4.80; P = 0.019] and PSA progression (HR, 1.96; 95% CI, 1.01-3.95; P = 0.048) in patients treated with ARAT, whereas such associations were not observed in those treated with docetaxel. Interaction analyses showed that those initially treated with docetaxel have lower risk of radiographic progression (HR, 0.33; 95% CI, 0.13-0.79; P = 0.014) and PSA progression (HR, 0.48; 95% CI, 0.23-0.98; P = 0.044) than ARAT when MPV was small.

CONCLUSIONS

The present study identified pretreatment MPV as a significant treatment-specific prognostic factor of PSA and radiographic progression in patients with mCRPC who received first-line treatment. Furthermore, our results suggested that those with small MPV may better be treated initially with docetaxel than ARAT.

Mean platelet volume-to-lymphocyte ratio: a novel biomarker associated with overall survival in patients with nonmetastatic clear cell renal cell carcinoma treated with nephrectomy

INTRODUCTION

Renal cell carcinoma is a highly aggressive malignancy that causes significant morbidity and mortality. The rising number of newly diagnosed renal tumors results in a great need to search for new preoperative markers to evaluate the course of the disease and to help select patients who would benefit the most from additional postoperative care. The aim of our study was to evaluate the prognostic value of mean platelet volume-to-lymphocyte ratio (MPVLR) in patients undergoing nephrectomy for nonmetastatic clear cell renal cell carcinoma (ccRCC).

MATERIALS AND METHODS

A total number of 344 patients with proven nonmetastatic ccRCC treated with radical or partial nephrectomy at our institution between January 2003 and December 2012 were included in our analysis. Based on the optimal cut-off value of MPVLR, which was determined by the receiver operating characteristic curve, our study population was divided into two groups, with low and high MPVLR. Differences in overall survival between groups were compared using the Kaplan-Meier method with log-rank testing. The Cox proportional hazards regression model was applied to perform univariate and multivariate analysis.

RESULTS

Study subjects with high MPVLR were older and had more advanced tumors. Tumor necrosis and higher TNM stages were also more prevalent in this group of patients. Mortality in patients with high MPVLR was significantly higher than in patients with low MPVLR. In the multivariate analysis, after adjustment for pathological and clinical covariates, high MPVLR (≥ 3.61) was independently associated with higher long-term overall mortality in nonmetastatic ccRCC patients.

CONCLUSION

MPVLR is an easily obtainable prognostic marker for overall survival in nonmetastatic ccRCC patients treated with nephrectomy.

Haematologic indices in hepatitis B virus-related liver disease

Several markers and prognostic scores have been identified for predicting the development and progression of liver disease; among them, haematological parameters (the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), red cell distribution width (RDW), RDW to platelet ratio (RPR), mean platelet volume (MPV), and mean corpuscular volume (MCV)) have recently gained significant interest. Compared with traditional prognostic factors, haematological indices are easy to obtain and relatively inexpensive. There is growing evidence that these haematological indices play a key role in HBV-related liver diseases and has been proposed as a predictive marker of adverse outcomes in these patients. This article focuses on discussing the diagnostic and prognostic value of the haematological indices in patients with HBV-related liver diseases.

A Retrospective Study of The Prognostic Significance of Preoperative Plasma Fibrinogen, Mean Platelet Volume, and the Neutrophil-to-Lymphocyte Ratio in Patients with Laryngeal Squamous Cell Carcinoma

BACKGROUND This study aimed to evaluate the prognostic significance of plasma fibrinogen, serum albumin, the mean platelet volume (MPV), and the neutrophil-to-lymphocyte ratio (NLR) in patients with laryngeal squamous cell carcinoma (LSCC) who underwent surgical resection. MATERIAL AND METHODS A retrospective study included 110 patients with LSCC who underwent surgical resection between January 2008 to June 2015. Clinicopathologic and demographic data were recorded. Preoperative levels of plasma fibrinogen, serum albumin, MPV, and NLR were measured, and all patients underwent postoperative follow-up. The Kaplan-Meier method was used to determine the impact of these factors on overall survival (OS) and disease-free survival (DFS). RESULTS Preoperative hyperfibrinogenemia was significantly correlated with clinical stage, T stage, and tumor location in patients with LSCC (P<0.05). Serum albumin, MPV, and NLR were significantly correlated with the clinical stage and the T stage (P<0.05). The OS and DFS were significantly reduced in patients with hyperfibrinogenemia compared with patients with plasma fibrinogen <4 g/dL (P<0.05). Serum albumin of 35 g/L was not significantly correlated with OS (P>0.05). Patients with an MPV <9.5 fL had a significantly longer OS compared with patients with an MPV ≥9.5 fL (P=0.026). The DFS of patients with an NLR <2.22 was significantly longer than for those with an NLR ≥2.22. CONCLUSIONS Preoperative hyperfibrinogenemia, increased MPV and NLR were associated with reduced prognosis in patients with LSCC.

Preoperative mean platelet volume predicts survival in breast cancer patients with type 2 diabetes

PURPOSE

Patients with type 2 diabetes mellitus (T2DM) have an increased risk of breast cancer (BC). Furthermore, growing evidence suggests that activated platelets play a crucial role in tumor and T2DM. Mean platelet volume (MPV) is a platelet index and is altered in patients with malignancies. The aim of this study was to determine whether preoperative MPV could predict survival in BC patients with T2DM.

METHODS

The clinical data of 266 female BC patients with T2DM and 264 female BC patients without T2DM between January 2011 and December 2011 in our center were retrospectively analyzed. Survival analysis was performed using the log-rank test and Cox proportional hazards regression analysis.

RESULTS

The patients with T2DM had higher MPV levels than the patients without T2DM. Furthermore, MPV was found to be significantly associated with differentiation T2DM from non-T2DM. In addition, survival analysis revealed that the disease-specific survival and overall survival of patients with MPV ≤ 8.0 fL were significantly shorter than that of those with MPV > 8.0 fL in diabetic patients. Multivariate analysis identified MPV as an independent poor prognostic factor for survival only in patients with T2DM not in patients without T2DM.

CONCLUSIONS

Our study first established a connection between MPV and BC patients with T2DM, suggesting that MPV was an independent prognostic factor and could be the biomarker for prognosis.

Mean platelet volume predicts survival in patients with hepatocellular carcinoma and type 2 diabetes

BACKGROUND

Patients with hepatocellular carcinoma (HCC) having pre-existing type 2 diabetes (T2DM) have a poorer prognosis than those without T2DM. Moreover, accumulating evidence reveals that activated platelets play a crucial role in tumor and T2DM. The mean platelet volume (MPV) indicates platelet activation and is altered in malignancies. The present study aimed to investigate the clinical significance of MPV in patients with HCC having T2DM.

METHODS

This retrospective study performed between January 2010 and December 2013 included 331 patients with HCC (165 with T2DM and 166 without T2DM). The overall survival was compared, and the predictors of overall survival were analyzed.

RESULTS

The patients with T2DM had lower MPV levels than those without T2DM. Furthermore, the MPV levels significantly differentiated T2DM from non-T2DM. In addition, for patients with T2DM, the overall survival was significantly shorter in patients with low MPV levels than in those with high MPV levels. Multivariate analysis identified decreased MPV as an independent prognostic factor for overall survival only in patients with T2DM, but not in those without T2DM.

CONCLUSION

Reduced MPV was a prognostic factor for poor outcome in patients with HCC and T2DM.

Association of Platelet Count and Mean Platelet Volume with Overall Survival in Patients with Cirrhosis and Unresectable Hepatocellular Carcinoma

BACKGROUND

Platelets have been reported to influence tumor biology and may promote metastasis. Traditionally, thrombocytopenia, a hallmark of cirrhosis, was associated with hepatocellular carcinoma (HCC) development. However, the impact of platelet count on outcome in patients with established HCC is not well studied.

METHODS

Outcomes of patients with cirrhosis diagnosed with HCC between 1995 and 2013 (derivation cohort) and 2000-2016 (validation cohort) who were not eligible for surgical treatment and did not receive antiplatelet therapy were retrospectively studied. Thrombocytopenia was defined as platelet count < 150 g/L. High mean platelet volume (MPV) was defined as ≥median value of the respective cohort (derivation cohort: ≥11 fL; validation cohort: ≥10.6 fL).

RESULTS

Among 626 patients with unresectable HCC, thrombocytopenia was present in 378 (60.4%) and was associated with favorable baseline tumor characteristics: lower diameter of the largest nodule (5.6 ± 3.2 vs. 7.6 ± 4.2 cm), less extrahepatic spread (9.5 vs. 20.2%, both p < 0.001), less macrovascular invasion (21.2 vs. 31.0%, p = 0.005), and lower BCLC stages (63.0 vs. 73.4% BCLC C/D; p = 0.007) as compared to patients with normal platelet count. On univariate analysis, thrombocytopenia and larger MPV were associated with longer overall survival (OS) (thrombocytopenia: median OS [95% CI], 11.5 [9.3-13.8] vs. 5.5 [3.8-7.1] months; p = 0.001; MPV ≥11 fL: 11.7 [9.1-14.2] vs. 6.0 [4.4-7.6] months; p < 0.001). In multivariate analysis, the combined variable of thrombocytopenia and larger MPV was independently associated with longer OS (HR [95% CI], 0.80 [0.65-0.98]; p = 0.029). These results were confirmed in an independent external validation cohort of 525 patients with cirrhosis and HCC. Again, patients with thrombocytopenia and high MPV had significantly longer OS (15.3 [11.7-18.9] vs. 9.3 [7.4-11.2] months; p < 0.001).

CONCLUSIONS

Thrombocytopenia and higher MPV are associated with better outcome in patients with advanced HCC. These findings may prompt further clinical research on additive antiplatelet therapy in the prevention and management of HCC.

Mean Platelet Volume (MPV): New Perspectives for an Old Marker in the Course and Prognosis of Inflammatory Conditions

Platelet size has been demonstrated to reflect platelet activity and seems to be a useful predictive and prognostic biomarker of cardiovascular events. It is associated with a variety of prothrombotic and proinflammatory diseases. The aim is a review of literature reports concerning changes in the mean platelet volume (MPV) and its possible role as a biomarker in inflammatory processes and neoplastic diseases. PubMed database was searched for sources using the following keywords: platelet activation, platelet count, mean platelet volume and: inflammation, cancer/tumor, cardiovascular diseases, myocardial infarction, diabetes, lupus disease, rheumatoid arthritis, tuberculosis, ulcerative colitis, renal disease, pulmonary disease, influencing factors, age, gender, genetic factors, oral contraceptives, smoking, lifestyle, methods, standardization, and hematological analyzer. Preference was given to the sources which were published within the past 20 years. Increased MPV was observed in cardiovascular diseases, cerebral stroke, respiratory diseases, chronic renal failure, intestine diseases, rheumatoid diseases, diabetes, and various cancers. Decreased MPV was noted in tuberculosis during disease exacerbation, ulcerative colitis, SLE in adult, and different neoplastic diseases. The study of MPV can provide important information on the course and prognosis in many inflammatory conditions. Therefore, from the clinical point of view, it would be interesting to establish an MPV cut-off value indicating the intensity of inflammatory process, presence of the disease, increased risk of disease development, increased risk of thrombotic complications, increased risk of death, and patient's response on applied treatment. Nevertheless, this aspect of MPV evaluation allowing its use in clinical practice is limited and requires further studies.

Neutrophil-to-mean platelet volume ratio as a new predictor for overall and cancer-specific survival in patients with localized clear cell renal cell carcinoma

INTRODUCTION

The present study investigated the prognostic value of neutrophil-to-mean platelet volume ratio (NMPVR) for overall (OS) and cancer-specific survival (CSS) in patients treated with nephrectomy for localized clear cell renal cell carcinoma (ccRCC).

MATERIAL AND METHODS

Medical records of 344 consecutive patients who underwent partial or radical nephrectomy for M0 ccRCC were retrospectively analyzed. Based on the median NMPVR, the study population was divided into two groups: the high NMPVR group with NMPVR higher than or equal to the median, and the low NMPVR group with NMPVR lower than the median. Comparisons of baseline characteristics and laboratory and pathological findings were performed. Kaplan-Meier survival curves and Cox regression model analysis were used to assess the prognostic value of the NMPVR.

RESULTS

Patients with higher NMPVR values were more frequently diagnosed with advanced disease, tumor necrosis and higher tumor grade. The OS and CSS were significantly shorter in patients with NMPVR ≥ 0.41 compared to patients with NMPVR < 0.41. Inclusion of NMPVR in multivariable models of OS and CSS with other confounding variables determined categorized NMPVR as an independent prognostic factor for both endpoints.

CONCLUSIONS

Pretreatment NMPVR ≥ 0.41 was associated with lower OS and CSS. NMPVR might be applied as a cheap and uncomplicated prognostic indicator in localized ccRCC patients treated with a primary surgical approach.

Prognostic value of mean platelet volume to plateletcrit ratio in patients with osteosarcoma

Objective

The objective of this study was to investigate the prognostic value of preoperative mean platelet volume to plateletcrit (MPV/PCT) ratio in patients with osteosarcoma.

Materials and methods

The retrospective study included 188 consecutive osteosarcoma patients who experienced neoadjuvant chemotherapy and surgical resection of tumor. The relationships between MPV/PCT and clinicopathological characteristics were analyzed. The Kaplan-Meier analysis and Cox regression proportional hazard model were applied to assess the prognostic value of MPV/PCT ratio.

Results

MPV/PCT ratio was found to be significantly associated with platelet count, platelet distribution width, and PCT (all P<0.001). Kaplan-Meier analysis showed that high MPV/PCT ratio (≥43.58) was associated with a prolonged disease-free survival (DFS, P=0.035). The multivariate Cox revealed that only good chemotherapy response was an independent predictor of better DFS in the overall population. However, the stratification analysis showed that a high MPV/PCT ratio (≥43.58) was indicated as an independent prognostic factor for a favorable DFS (HR =0.137, 95%CI =0.029-0.644, P=0.012) in the male osteosarcoma patients but not in female patients.

Conclusion

The high preoperative MPV/PCT ratio may serve as an independent prognostic factor for a favorable prognosis in male osteosarcoma patients. Further studies are needed to confirm the findings.

Decreased mean platelet volume predicts poor prognosis in metastatic colorectal cancer patients treated with first-line chemotherapy: results from mCRC biomarker study

BACKGROUND

Metastatic colorectal cancer (mCRC) is a major cause of death of malignant tumor and the valuable prognostic biomarker for chemotherapy is crucial in decreasing mortality. Previous studies have proved the prognostic value of the mean platelet volume (MPV) in survival of primary operable CRC patients. However, the prognostic impact of MPV in mCRC is still unclear. In this study, we aimed to clarify the prognostic role of MPV in mCRC undergoing standard first-line chemotherapy.

METHODS

From January 2012 to December 2016, we conducted a retrospective clinical study included 264 mCRC patients (NCT03532711). All the enrolled patients received the standard oxaliplatin-based or irinotecan-based chemotherapy. The association between the baseline MPV and clinicopathological features were examined.

RESULTS

Univariate analysis revealed that decreased MPV, the platelet counts (PLT), platelet-to-lymphocyte ratio (PLR) and the platelet crit (PCT) were significantly associated with inferior overall survival (OS) (p < 0.05). On multivariate analysis, elevated PLR was significant prognostic factors for OS, with hazard ratios of (HR:1.006, 95% CI:1.001-1.011, p = 0.01) while MPV was not, respectively (p < 0.05).

CONCLUSIONS

Our study demonstrated that the baseline MPV level may act as a predictive factor for survival in mCRC patients undergoing standard chemotherapy.

TRIAL REGISTRATION

This study was retrospectively registered in date May the 20th 2018. The registration number (TRN) of this study was NCT03532711 .