The preoperative platelet distribution width: A predictive factor of the prognosis in patients with non-small cell lung cancer

Establishment and validation of a nomogram based on coagulation parameters to predict the prognosis of pancreatic cancer

BACKGROUND

In recent years, multiple coagulation and fibrinolysis (CF) indexes have been reported to be significantly related to the progression and prognosis of some cancers.

OBJECTIVE

The purpose of this study was to comprehensively analyze the value of CF parameters in prognosis prediction of pancreatic cancer (PC).

METHODS

The preoperative coagulation related data, clinicopathological information, and survival data of patients with pancreatic tumor were collected retrospectively. Mann Whitney U test, Kaplan-Meier analysis, and Cox proportional hazards regression model were applied to analyze the differences of coagulation indexes between benign and malignant tumors, as well as the roles of these indexes in PC prognosis prediction.

RESULTS

Compared with benign tumors, the preoperative levels of some traditional coagulation and fibrinolysis (TCF) indexes (such as TT, Fibrinogen, APTT, and D-dimer) were abnormally increased or decreased in patients with pancreatic cancer, as well as Thromboelastography (TEG) parameters (such as R, K, α Angle, MA, and CI). Kaplan Meier survival analysis based on resectable PC patients showed that the overall survival (OS) of patients with elevated α angle, MA, CI, PT, D-dimer, or decreased PDW was markedly shorter than other patients; moreover, patients with lower CI or PT have longer disease-free survival. Further univariate and multivariate analysis revealed that PT, D-dimer, PDW, vascular invasion (VI), and tumor size (TS) were independent risk factors for poor prognosis of PC. According to the results of modeling group and validation group, the nomogram model based on independent risk factors could effectively predict the postoperative survival of PC patients.

CONCLUSION

Many abnormal CF parameters were remarkably correlated with PC prognosis, including α Angle, MA, CI, PT, D-dimer, and PDW. Furthermore, only PT, D-dimer, and PDW were independent prognostic indicators for poor prognosis of PC, and the prognosis prediction model based on these indicators was an effective tool to predict the postoperative survival of PC.

Pretreatment Platelet Count is a Prognostic Marker in Lung Cancer: A Danish Registry-based Cohort Study

BACKGROUND

Thrombocytosis has been associated with a poor prognosis in a wide range of malignancies. However, the results have been conflicting for lung cancer. Therefore, we evaluated the prognostic value of platelet count in a large cohort of lung cancer patients.

PATIENTS AND METHODS

All lung cancer patients diagnosed in The Central Denmark Region from 2009 to 2018 were included in the study. Data from the Danish Lung Cancer Registry were combined with data from the clinical laboratory information system on pretreatment platelet count. Platelet count was defined as low, normal, or high based on being below, within, or above the reference intervals. The prognostic value of platelet count was assessed by the Cox proportional hazard model. C-statistics were conducted to investigate if the platelet count added additional prognostic value to existing prognostic markers.

RESULTS

Totally, 6,758 patients with non-small-cell lung cancer (NSCLC) and 1150 patients with small-cell lung cancer (SCLC) were included. Low and high platelet count were significantly associated with decreased overall survival (OS) in NSCLC patients (low: adjusted hazard ratio (HR)=1.75 (95% confidence interval [CI]: 1.49-2.06); high: adjusted HR=1.24 (95% CI: 1.16-1.33)). In SCLC patients, only low platelet count was significantly associated with decreased OS (adjusted HR = 2.71 [95% CI: 2.02-3.65]). C-statistics showed that the prognostic models were significantly improved by the addition of platelet count for both NSCLC and SCLC patients (P < .0001).

CONCLUSION

Low and high platelet count were adverse prognostic factors in NSCLC patients, while only low platelet count was a prognostic marker in SCLC patients.

A combined preoperative red cell distribution width and carcinoembryonic antigen score contribute to prognosis prediction in stage I lung adenocarcinoma

AIMS

Hematological markers that can be used for prognosis prediction for stage I lung adenocarcinoma (LUAD) are still lacking. Here, we examined the prognostic value of a combination of the red cell distribution width (RDW) and carcinoembryonic antigen (CEA), namely, the RDW-CEA score (RCS), in stage I LUAD.

MATERIALS AND METHODS

A retrospective study with 154 patients with stage I LUAD was conducted. Patients were divided into RCS 1 (decreased RDW and CEA), RCS 2 (decreased RDW and increased CEA, increased RDW and decreased CEA), and RCS 3 (increased RDW and CEA) subgroups based on the best optimal cutoff points of RDW and CEA for overall survival (OS). The differences in other clinicopathological parameters among RCS subgroups were calculated. Disease-free survival (DFS) and OS among these groups were determined by Kaplan-Meier analysis, and risk factors for outcome were calculated by a Cox proportional hazards model.

RESULTS

Seventy, 65, and 19 patients were assigned to the RCS 1, 2, and 3 subgroups, respectively. Patients ≥ 60 years (P < 0.001), male sex (P = 0.004), T₂ stage (P = 0.004), and IB stage (P = 0.006) were more significant in the RCS 2 or 3 subgroups. The RCS had a good area under the curve (AUC) for predicting DFS (AUC = 0.81, P < 0.001) and OS (AUC = 0.93, P < 0.001). The DFS (log-rank = 33.26, P < 0.001) and OS (log-rank = 42.05, P < 0.001) were significantly different among RCS subgroups, with RCS 3 patients displaying the worst survival compared to RCS 1 or 2 patients. RCS 3 was also an independent risk factor for both DFS and OS.

CONCLUSIONS

RCS is a useful prognostic indicator in stage I LUAD patients, and RCS 3 patients have poorer survival. However, randomized controlled trials are needed to validate our findings in the future.

Preoperative PDW levels predict pulmonary metastasis in patients with hepatocellular carcinoma

Background

In hepatocellular carcinoma (HCC), pulmonary metastasis (PM) after hepatectomy is associated with poor clinical outcomes. The crucial phases of tumour cell proliferation, angiogenesis, and metastasis all entail platelet activation. In HCC, platelet distribution width (PDW) suggests platelet size changes and predicts a worse prognosis. The aim of this study was to assess the association between PDW and PMs in HCC patients receiving hepatectomy.

Material/methods

From January 2013 to December 2015, a cohort of patients who underwent hepatectomy for HCC at the Harbin Medical University Cancer Hospital in China were retrospectively evaluated. The relationship between PDW levels and clinical and demographic parameters was examined. To investigate the relationships between predicted factors and PM, a competing risk model was used. From January 2016 to December 2018, a validation cohort of 109 patients from the First Affiliated Hospital of Harbin Medical University was studied independently.

Results

In the primary cohort, 19 out of 214 patients had postoperative PMs. In HCC patients with PM, PDW levels were lower than in those without PM. There was a significant difference in the cumulative incidence of 2-year PM between the high-PDW and low-PDW groups after controlling for competing risk events (death prior to the development of PM) (p < 0.001). In addition, PDW was also found to be an independent predictor for PM in a multivariable competing risk analysis. The results were externally validated in another cohort.

Conclusions

In HCC, preoperative PDW is significantly associated with PM. PDW could be a biomarker for post-operative PM in HCC patients.

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.

Prognostic significance of thrombocytosis in lung cancer: a systematic review and meta-analysis

A potential relationship between poor prognosis and thrombocytosis has been suggested by previous studies in lung cancer, but the conclusions continued to be controversial. Here, we performed a meta-analysis to explore the prognostic impact of thrombocytosis in lung cancer. The Cochrane Library, EMBASE and PubMed databases were comprehensively and systematically retrieved from establishment to May 5, 2020. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were applied to evaluate overall effects. Heterogeneity was assessed using I² statistics and Cochran's Q test. Sensitivity and subgroup analyses were performed to analyze the sources of heterogeneity. Publication bias was examined using the Egger's test and pooled HR was regulated using the trim-and-fill approach when publication bias was observed. A total of 37 studies including 14,833 patients were enrolled in the meta-analysis. Thrombocytosis was significantly correlated to poor overall survival (HR 1.033; 95% CI 1.017-1.050), disease-free survival (HR 1.568; 95% CI 1.276-1.928), and progression-free survival (HR 1.653; 95% CI 1.069-2.556). Although publication bias was identified, rectification for this bias using the trim-and-fill approach did not change the combined HR substantially. In conclusion, this meta-analysis result suggested that thrombocytosis is a predictor of poor prognosis in lung cancer.

[Prognostic value of preoperative platelet parameters in locally advanced renal cell carcinoma]

OBJECTIVE

To explore the prognostic value of preoperative platelet parameters in locally advanced renal cell carcinoma for the risk stratification of such patients.

METHODS

Clinical data of patients with locally advanced renal cell carcinoma in the Third Hospital of Peking University from January 2015 to December 2017 were collected. The patients were divided into progression group and progression-free group according to follow-up data, and preoperative platelet parameters and clinical data between the two groups were compared. The optimal cut-off value of platelet parameters was determined by receiver operating characteristic curve (ROC) and analyzed by Kaplan-Meier survival curve. Cox proportional hazards model was used to analyze the independent risk factors of PFS. Time dependent ROC curve, net reclassification index (NRI), and integrated discrimination improvement (IDI) were used to evaluate the improvement of SSIGN model by incorporating platelet parameters.

RESULTS

Of the 215 patients, 192 (89.3%) were followed up for a median of 36 months. Sixty-four patients (29.8%) had disease progression during the follow-up, and the median PFS was 46 months. In progression group, the platelet count (PLT) was higher [(250.72 ± 88.59)×10⁹/L vs. (227.27 ± 66.94)×10⁹/L, P=0.042] and the platelet distribution width (PDW) was lower [(12.01 ± 2.27)% vs. (13.31 ± 2.74)%, P = 0.001] than that of progression-free groups. 285×10⁹ /L and 12.65% as the best cut-off values of PLT and PDW, the median PFS of PLT≤285×10⁹ /L group was significantly longer than that of PLT>285×10⁹ /L group (53 months vs. 41 months, P=0.033), and the median PFS of PDW>12.65% group was also significantly longer than that of PDW≤12.65% group (56 months vs. 41 months, P < 0.001). Multivariate analysis showed that preoperative PDW (HR=0.735, P < 0.001), nuclear grade Ⅲ to Ⅳ (HR=2.425, P=0.001) and sarcomatoid differentiation (HR=3.101, P=0.008) were independent risk factors for PFS. The area under the curve of PDW combined with SSIGN model was larger than that with the original SSIGN model [0.748 (95%CI: 0.662－0.833) vs. 0.678 (95%CI: 0.583－0.773), P=0.193], NRI was 0.262 (P=0.04), and IDI was 0.085 (P=0.01), indicating that the predictive ability of PDW combined with SSIGN model was improved.

CONCLUSION

Preoperative high PLT and low PDW are associated with adverse prognosis of locally advanced renal cell carcinoma, and PDW is an independent risk factor. Therefore, preoperative PDW could serve as biomarker for risk stratification of locally advanced renal cell carcinoma.

Prognostic value of platelet distribution width and mean platelet volume in patients with laryngeal cancer

Aims: To investigate the prognostic relevance of platelet volume indices for survival in laryngeal cancer. Patients & methods: The study included 640 patients with laryngeal cancer. We analyzed the optimal cutoff values through receiver operating characteristic analysis, then analyzed the univariate factor and multivariate variables. Kaplan-Meier curves and log-rank tests were conducted to compare the overall survival (OS) and recurrence-free survival rates between the groups. Results: In multivariate analysis, elevated platelet distribution width (PDW) and PDW/platelet count ratio were significantly correlated with poor prognosis for OS; however, elevated mean platelet volume (MPV) and MPV/platelet count ratio suggested a notable correlation with favorable prognosis for OS. Meanwhile, elevated PDW and decreased MPV were significantly correlated with poor prognosis for recurrence-free survival. Conclusions: Our findings indicate that elevated PDW and decreased MPV could serve as independent biomarkers for worse survival in laryngeal cancer.