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Mounce LTA, Calitri R, Hamilton W, Rafiq M, Emery JD, Giannakeas V, Kotsopoulos J, Bailey SER. Improving the Clinical Utility of Platelet Count for Cancer Detection in Primary Care: A Cohort Study in England, Canada, and Australia. Cancers (Basel) 2024; 16:3074. [PMID: 39272932 PMCID: PMC11394200 DOI: 10.3390/cancers16173074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 08/27/2024] [Accepted: 08/29/2024] [Indexed: 09/15/2024] Open
Abstract
The platelet count, a component of the full blood count, has been identified as a useful diagnostic marker for cancer in primary care. The reference range for the platelet count is 150 to 400 or 450 × 109/L; this range does not account for natural variation in platelet count by age and sex. This study used three primary care cohorts from England, Canada, and Australia. Patients aged 40 years and over with a full blood count were included and stratified by age (in 10-year bands), sex, (male/female), and platelet count group. Cancer incidence within one year of the test date was estimated from linked registry data. In all three countries, there was a clear upwards trend in cancer incidence with increasing platelet count for both sexes and at all age groups. Lung and colorectal were the most common sites. These results have important implications for the international application of this work; analysis of local health datasets will be crucial to determining appropriate thresholds. Appropriate upper thresholds will depend on local populations, healthcare needs, and priorities. Further research is needed to assess the likely impact of new recommendations on the healthcare system, on cancer outcomes, and patient benefit.
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Affiliation(s)
- Luke T A Mounce
- University of Exeter Medical School, University of Exeter, Exeter EX1 3DB, UK
| | - Raff Calitri
- University of Exeter Medical School, University of Exeter, Exeter EX1 3DB, UK
| | - Willie Hamilton
- University of Exeter Medical School, University of Exeter, Exeter EX1 3DB, UK
| | - Meena Rafiq
- Department of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London WC1E 7HB, UK
| | - Jon D Emery
- Department of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia
| | - Vasily Giannakeas
- Research and Innovation Institute, Women's College Hospital, Toronto, ON M5S 1B2, Canada
- ICES, Toronto, ON M5T 3M6, Canada
| | - Joanne Kotsopoulos
- Research and Innovation Institute, Women's College Hospital, Toronto, ON M5S 1B2, Canada
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Sarah E R Bailey
- University of Exeter Medical School, University of Exeter, Exeter EX1 3DB, UK
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2
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Watson J, Duncan P, Burrell A, Bennett-Britton I, Hodgson S, Merriel SWD, Waqar S, Razumovskaya-Hough A, Whiting PF. Patient safety in actioning and communicating blood test results in primary care: a UK wide audit using the Primary care Academic CollaboraTive (PACT). BMJ Open Qual 2024; 13:e002632. [PMID: 39059792 DOI: 10.1136/bmjoq-2023-002632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Errors associated with failures in filing, actioning and communicating blood test results can lead to delayed and missed diagnoses and patient harm. This study aimed to audit how blood tests in primary care are filed, actioned and communicated in primary care, to identify areas for patient safety improvements. METHODS UK primary care clinicians were recruited through the Primary Care Academic CollaboraTive (PACT). PACT members audited 50 recent sets of blood tests from their practice and retrospectively extracted data on blood test result coding, actioning and communication. PACT members received a practice report, showing their own results, benchmarked against other participating practices. RESULTS PACT members from 57 general practices across all four UK nations collected data on 2572 patients who had blood tests in April 2021. In 89.9% (n=2311) they agreed with the initial clinician's actioning of blood tests; 10.1% disagreed, either partially (7.1%) or fully (3.0%).In 44% of patients (n=1132) an action (eg, 'make an appointment') was specified by the filing clinician. This action was carried out in 89.7% (n=1015/1132) of cases; in 6.8% (n=77) the action was not carried out, in 3.5% (n=40) it was unclear. In the 117 cases where the test result had not been actioned 38% (n=45) were felt to be at low risk of harm, 1.7% (n=2) were at high risk of harm, 0.85% (n=1) came to harm.Overall, in 47% (n=1210) of patients there was no evidence in the electronic health records that results had been communicated. Out of 1176 patients with one or more abnormal results there was no evidence of test communication in 30.6% (n=360). There were large variations between practices in rates of actioning and communicating tests. CONCLUSION This research demonstrates variation in the way blood test results are actioned and communicated, with important patient safety implications.
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Affiliation(s)
- Jessica Watson
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Polly Duncan
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | | | | | - Samuel W D Merriel
- Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, Exeter, UK
- Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, UK
| | | | | | - Penny F Whiting
- Population Health Sciences, University of Bristol, Bristol, UK
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3
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Rafiq M, Renzi C, White B, Zakkak N, Nicholson B, Lyratzopoulos G, Barclay M. Predictive value of abnormal blood tests for detecting cancer in primary care patients with nonspecific abdominal symptoms: A population-based cohort study of 477,870 patients in England. PLoS Med 2024; 21:e1004426. [PMID: 39078806 PMCID: PMC11288431 DOI: 10.1371/journal.pmed.1004426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 06/13/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Identifying patients presenting with nonspecific abdominal symptoms who have underlying cancer is a challenge. Common blood tests are widely used to investigate these symptoms in primary care, but their predictive value for detecting cancer in this context is unknown. We quantify the predictive value of 19 abnormal blood test results for detecting underlying cancer in patients presenting with 2 nonspecific abdominal symptoms. METHODS AND FINDINGS Using data from the UK Clinical Practice Research Datalink (CPRD) linked to the National Cancer Registry, Hospital Episode Statistics and Index of Multiple Deprivation, we conducted a population-based cohort study of patients aged ≥30 presenting to English general practice with abdominal pain or bloating between January 2007 and October 2016. Positive and negative predictive values (PPV and NPV), sensitivity, and specificity for cancer diagnosis (overall and by cancer site) were calculated for 19 abnormal blood test results co-occurring in primary care within 3 months of abdominal pain or bloating presentations. A total of 9,427/425,549 (2.2%) patients with abdominal pain and 1,148/52,321 (2.2%) with abdominal bloating were diagnosed with cancer within 12 months post-presentation. For both symptoms, in both males and females aged ≥60, the PPV for cancer exceeded the 3% risk threshold used by the UK National Institute for Health and Care Excellence for recommending urgent specialist cancer referral. Concurrent blood tests were performed in two thirds of all patients (64% with abdominal pain and 70% with bloating). In patients aged 30 to 59, several blood abnormalities updated a patient's cancer risk to above the 3% threshold: For example, in females aged 50 to 59 with abdominal bloating, pre-blood test cancer risk of 1.6% increased to: 10% with raised ferritin, 9% with low albumin, 8% with raised platelets, 6% with raised inflammatory markers, and 4% with anaemia. Compared to risk assessment solely based on presenting symptom, age and sex, for every 1,000 patients with abdominal bloating, assessment incorporating information from blood test results would result in 63 additional urgent suspected cancer referrals and would identify 3 extra cancer patients through this route (a 16% relative increase in cancer diagnosis yield). Study limitations include reliance on completeness of coding of symptoms in primary care records and possible variation in PPVs if extrapolated to healthcare settings with higher or lower rates of blood test use. CONCLUSIONS In patients consulting with nonspecific abdominal symptoms, the assessment of cancer risk based on symptoms, age and sex alone can be substantially enhanced by considering additional information from common blood test results. Male and female patients aged ≥60 presenting to primary care with abdominal pain or bloating warrant consideration for urgent cancer referral or investigation. Further cancer assessment should also be considered in patients aged 30 to 59 with concurrent blood test abnormalities. This approach can detect additional patients with underlying cancer through expedited referral routes and can guide decisions on specialist referrals and investigation strategies for different cancer sites.
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Affiliation(s)
- Meena Rafiq
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, United Kingdom
- Department of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - Cristina Renzi
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, United Kingdom
- Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - Becky White
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, United Kingdom
| | - Nadine Zakkak
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, United Kingdom
| | - Brian Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, United Kingdom
| | - Matthew Barclay
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, United Kingdom
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Yudistira G, Sudiro M, Afriani Dewi Y. Value of Platelet to Lymphocyte Ratio in Nasopharyngeal Carcinoma Various Stages. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2024; 36:467-473. [PMID: 38745688 PMCID: PMC11090094 DOI: 10.22038/ijorl.2024.75070.3523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/05/2024] [Indexed: 05/16/2024]
Abstract
Introduction Nasopharyngeal Carcinoma (NPC) is among the most common head and neck cancer, significantly affecting the growth of human tumors. Therefore, this study aimed to investigate platelet-to-lymphocyte ratio (PLR) as a measure of inflammation in patients with various stages of NPC. Materials and Methods This retrospective case-control study was conducted on patients diagnosed with NPC between 2016 and 2020 in Dr. Hasan Sadikin Bandung Hospital, Indonesia. Based on NPC classification criteria, patients were classified into early and advanced groups. Subsequently, the PLR ratio was calculated as the number of platelet divided by the absolute number of lymphocytes in the two groups, and the results were statistically analyzed using Unpaired T-test, Pearson, and Chi-square test. Results A total of 102 patients with an age range of 40 to 49 years were included in this study. A slight correlation of 0.272 (P<0.001) was observed between PLR and clinical stage, while NPC patients with PLR value > 188 had a 2.7 times higher risk of advanced stage (RR=2.702). Conclusion The PLR was significantly related to the clinical stage of NPC cancer.
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Affiliation(s)
- Goesti Yudistira
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine Padjadjaran University/ Dr. Hasan Sadikin General Hospital Bandung, Indonesia.
| | - Melati Sudiro
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine Padjadjaran University/ Dr. Hasan Sadikin General Hospital Bandung, Indonesia.
| | - Yussy Afriani Dewi
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine Padjadjaran University/ Dr. Hasan Sadikin General Hospital Bandung, Indonesia.
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Watson J, Burrell A, Duncan P, Bennett-Britton I, Hodgson S, Merriel SW, Waqar S, Whiting PF. Exploration of reasons for primary care testing (the Why Test study): a UK-wide audit using the Primary care Academic CollaboraTive. Br J Gen Pract 2024; 74:e133-e140. [PMID: 37783511 PMCID: PMC10562996 DOI: 10.3399/bjgp.2023.0191] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/05/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Rates of blood testing have increased over the past two decades. Reasons for testing cannot easily be extracted from electronic health record databases. AIM To explore who requests blood tests and why, and what the outcomes of testing are in UK primary care. DESIGN AND SETTING A retrospective audit of electronic health records in general practices in England, Wales, Scotland, and Northern Ireland was undertaken. METHOD Fifty-seven clinicians from the Primary care Academic CollaboraTive (PACT) each reviewed the electronic health records of 50 patients who had blood tests in April 2021. Anonymised data were extracted including patient characteristics, who requested the tests, reasons for testing, test results, and outcomes of testing. RESULTS Data were collected from 2572 patients across 57 GP practices. The commonest reasons for testing in primary care were investigation of symptoms (43.2%), monitoring of existing disease (30.1%), monitoring of existing medications (10.1%), and follow up of previous abnormalities (6.8%); patient requested testing was rare in this study (1.5%). Abnormal and borderline results were common, with 26.6% of patients having completely normal test results. Around one-quarter of tests were thought to be partially or fully unnecessary when reviewed retrospectively by a clinical colleague. Overall, 6.2% of tests in primary care led to a new diagnosis or confirmation of a diagnosis. CONCLUSION The utilisation of a national collaborative model (PACT) has enabled a unique exploration of the rationale and outcomes of blood testing in primary care, highlighting areas for future research and optimisation.
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Affiliation(s)
- Jessica Watson
- National Institute for Health and Care Research doctoral research fellow
| | - Alexander Burrell
- National Institute for Health and Care Research doctoral research fellow
| | - Polly Duncan
- National Institute for Health and Care Research doctoral research fellow
| | | | - Sam Hodgson
- Wolfson Institute of Population Health, Queen Mary University of London, London
| | - Samuel Wd Merriel
- Exeter Collaboration for Academic Primary Care, Exeter Medical School, University of Exeter, Exeter; Centre for Primary Care & Health Services Research, University of Manchester, Manchester
| | - Salman Waqar
- Department of Primary Care and Public Health, Imperial College London, London
| | - Penny F Whiting
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
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Guha A, Goswami KK, Sultana J, Ganguly N, Choudhury PR, Chakravarti M, Bhuniya A, Sarkar A, Bera S, Dhar S, Das J, Das T, Baral R, Bose A, Banerjee S. Cancer stem cell-immune cell crosstalk in breast tumor microenvironment: a determinant of therapeutic facet. Front Immunol 2023; 14:1245421. [PMID: 38090567 PMCID: PMC10711058 DOI: 10.3389/fimmu.2023.1245421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023] Open
Abstract
Breast cancer (BC) is globally one of the leading killers among women. Within a breast tumor, a minor population of transformed cells accountable for drug resistance, survival, and metastasis is known as breast cancer stem cells (BCSCs). Several experimental lines of evidence have indicated that BCSCs influence the functionality of immune cells. They evade immune surveillance by altering the characteristics of immune cells and modulate the tumor landscape to an immune-suppressive type. They are proficient in switching from a quiescent phase (slowly cycling) to an actively proliferating phenotype with a high degree of plasticity. This review confers the relevance and impact of crosstalk between immune cells and BCSCs as a fate determinant for BC prognosis. It also focuses on current strategies for targeting these aberrant BCSCs that could open avenues for the treatment of breast carcinoma.
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Affiliation(s)
- Aishwarya Guha
- Department of Immunoregulation and Immunodiagnostics, Chittaranjan National Cancer Institute, Kolkata, India
| | | | - Jasmine Sultana
- Department of Immunoregulation and Immunodiagnostics, Chittaranjan National Cancer Institute, Kolkata, India
| | - Nilanjan Ganguly
- Department of Immunoregulation and Immunodiagnostics, Chittaranjan National Cancer Institute, Kolkata, India
| | - Pritha Roy Choudhury
- Department of Immunoregulation and Immunodiagnostics, Chittaranjan National Cancer Institute, Kolkata, India
| | - Mohona Chakravarti
- Department of Immunoregulation and Immunodiagnostics, Chittaranjan National Cancer Institute, Kolkata, India
| | - Avishek Bhuniya
- Department of Immunoregulation and Immunodiagnostics, Chittaranjan National Cancer Institute, Kolkata, India
| | - Anirban Sarkar
- Department of Immunoregulation and Immunodiagnostics, Chittaranjan National Cancer Institute, Kolkata, India
| | - Saurav Bera
- Department of Immunoregulation and Immunodiagnostics, Chittaranjan National Cancer Institute, Kolkata, India
| | - Sukanya Dhar
- Department of Immunoregulation and Immunodiagnostics, Chittaranjan National Cancer Institute, Kolkata, India
| | - Juhina Das
- Department of Immunoregulation and Immunodiagnostics, Chittaranjan National Cancer Institute, Kolkata, India
| | - Tapasi Das
- Department of Immunoregulation and Immunodiagnostics, Chittaranjan National Cancer Institute, Kolkata, India
| | - Rathindranath Baral
- Department of Immunoregulation and Immunodiagnostics, Chittaranjan National Cancer Institute, Kolkata, India
| | - Anamika Bose
- Department of Pharmaceutical Technology Biotechnology National Institute of Pharmaceutical Education and Research (NIPER) Sahibzada Ajit Singh (S.A.S.) Nagar, Mohali, Punjab, India
| | - Saptak Banerjee
- Department of Immunoregulation and Immunodiagnostics, Chittaranjan National Cancer Institute, Kolkata, India
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7
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Christakoudi S, Tsilidis KK, Evangelou E, Riboli E. Interactions of platelets with obesity in relation to lung cancer risk in the UK Biobank cohort. Respir Res 2023; 24:249. [PMID: 37848891 PMCID: PMC10580651 DOI: 10.1186/s12931-023-02561-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Platelet count (PLT) is associated positively with lung cancer risk but has a more complex association with body mass index (BMI), positive only in women (mainly never smokers) and inverse in men (mainly ever smokers), raising the question whether platelets interact with obesity in relation to lung cancer risk. Prospective associations of platelet size (an index of platelet maturity and activity) with lung cancer risk are unclear. METHODS We examined the associations of PLT, mean platelet volume (MPV), and platelet distribution width (PDW) (each individually, per one standard deviation increase) with lung cancer risk in UK Biobank men and women using multivariable Cox proportional hazards models adjusted for BMI and covariates. We calculated Relative Excess Risk from Interaction (RERI) with obese (BMI ≥ 30 kg/m2), dichotomising platelet parameters at ≥ median (sex-specific), and multiplicative interactions with BMI (continuous scale). We examined heterogeneity according to smoking status (never, former, current smoker) and antiaggregant/anticoagulant use (no/yes). RESULTS During a mean follow-up of 10.4 years, 1620 lung cancers were ascertained in 192,355 men and 1495 lung cancers in 218,761 women. PLT was associated positively with lung cancer risk in men (hazard ratio HR = 1.14; 95% confidence interval (CI): 1.09-1.20) and women (HR = 1.09; 95%CI: 1.03-1.15) but interacted inversely with BMI only in men (RERI = - 0.53; 95%CI: - 0.80 to - 0.26 for high-PLT-obese; HR = 0.92; 95%CI = 0.88-0.96 for PLT*BMI). Only in men, MPV was associated inversely with lung cancer risk (HR = 0.95; 95%CI: 0.90-0.99) and interacted positively with BMI (RERI = 0.27; 95%CI = 0.09-0.45 for high-MPV-obese; HR = 1.08; 95%CI = 1.04-1.13 for MPV*BMI), while PDW was associated positively (HR = 1.05; 95%CI: 1.00-1.10), with no evidence for interactions. The associations with PLT were consistent by smoking status, but MPV was associated inversely only in current smokers and PDW positively only in never/former smokers. The interactions with BMI were retained for at least eight years of follow-up and were consistent by smoking status but were attenuated in antiaggregant/anticoagulant users. CONCLUSIONS In men, PLT was associated positively and MPV inversely with lung cancer risk and these associations appeared hindered by obesity. In women, only PLT was associated positively, with little evidence for interaction with obesity.
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Affiliation(s)
- Sofia Christakoudi
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK.
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, London, UK.
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Evangelos Evangelou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
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Joharatnam-Hogan N, Hatem D, Cafferty FH, Petrucci G, Cameron DA, Ring A, Kynaston HG, Gilbert DC, Wilson RH, Hubner RA, Swinson DEB, Cleary S, Robbins A, MacKenzie M, Scott-Brown MWG, Sothi S, Dawson LK, Capaldi LM, Churn M, Cunningham D, Khoo V, Armstrong AC, Ainsworth NL, Horan G, Wheatley DA, Mullen R, Lofts FJ, Walther A, Herbertson RA, Eaton JD, O'Callaghan A, Eichholz A, Kagzi MM, Patterson DM, Narahari K, Bradbury J, Stokes Z, Rizvi AJ, Walker GA, Kunene VL, Srihari N, Gentry-Maharaj A, Meade A, Patrono C, Rocca B, Langley RE. Thromboxane biosynthesis in cancer patients and its inhibition by aspirin: a sub-study of the Add-Aspirin trial. Br J Cancer 2023; 129:706-720. [PMID: 37420000 PMCID: PMC10421951 DOI: 10.1038/s41416-023-02310-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/09/2023] [Accepted: 06/05/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Pre-clinical models demonstrate that platelet activation is involved in the spread of malignancy. Ongoing clinical trials are assessing whether aspirin, which inhibits platelet activation, can prevent or delay metastases. METHODS Urinary 11-dehydro-thromboxane B2 (U-TXM), a biomarker of in vivo platelet activation, was measured after radical cancer therapy and correlated with patient demographics, tumour type, recent treatment, and aspirin use (100 mg, 300 mg or placebo daily) using multivariable linear regression models with log-transformed values. RESULTS In total, 716 patients (breast 260, colorectal 192, gastro-oesophageal 53, prostate 211) median age 61 years, 50% male were studied. Baseline median U-TXM were breast 782; colorectal 1060; gastro-oesophageal 1675 and prostate 826 pg/mg creatinine; higher than healthy individuals (~500 pg/mg creatinine). Higher levels were associated with raised body mass index, inflammatory markers, and in the colorectal and gastro-oesophageal participants compared to breast participants (P < 0.001) independent of other baseline characteristics. Aspirin 100 mg daily decreased U-TXM similarly across all tumour types (median reductions: 77-82%). Aspirin 300 mg daily provided no additional suppression of U-TXM compared with 100 mg. CONCLUSIONS Persistently increased thromboxane biosynthesis was detected after radical cancer therapy, particularly in colorectal and gastro-oesophageal patients. Thromboxane biosynthesis should be explored further as a biomarker of active malignancy and may identify patients likely to benefit from aspirin.
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Affiliation(s)
| | - Duaa Hatem
- Department of Safety and Bioethics, Division of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | - Fay H Cafferty
- MRC Clinical Trials Unit, UCL, London, UK
- The Institute of Cancer Research, London, UK
| | - Giovanna Petrucci
- Department of Safety and Bioethics, Division of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | - David A Cameron
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, The University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Alistair Ring
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Howard G Kynaston
- Department of Urology, Cardiff University School of Medicine, Cardiff, UK
| | - Duncan C Gilbert
- MRC Clinical Trials Unit, UCL, London, UK
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Richard H Wilson
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Richard A Hubner
- The Christie NHS Foundation Trust, Department of Medical Oncology, Manchester, UK
- University of Manchester, Division of Cancer Sciences, Manchester, UK
| | | | | | | | | | | | - Sharmila Sothi
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Lesley K Dawson
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | | | - Mark Churn
- Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | | | - Vincent Khoo
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Anne C Armstrong
- The Christie NHS Foundation Trust, Department of Medical Oncology, Manchester, UK
| | - Nicola L Ainsworth
- The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Gail Horan
- The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | | | - Russell Mullen
- The Highland Breast Centre, Raigmore Hospital, Inverness, UK
| | - Fiona J Lofts
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Axel Walther
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - John D Eaton
- University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, UK
| | | | | | | | | | - Krishna Narahari
- University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
- Division of Cancer and Genetics, Cardiff University, Cardiff, UK
| | | | - Zuzana Stokes
- United Lincolnshire Hospitals NHS Trust, Lincoln City, UK
| | - Azhar J Rizvi
- Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | | | - Victoria L Kunene
- Walsall Manor Hospital and University Hospitals, Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | | | - Carlo Patrono
- Department of Safety and Bioethics, Division of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | - Bianca Rocca
- Department of Safety and Bioethics, Division of Pharmacology, Catholic University School of Medicine, Rome, Italy
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9
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Anderson R, Rapoport BL, Steel HC, Theron AJ. Pro-Tumorigenic and Thrombotic Activities of Platelets in Lung Cancer. Int J Mol Sci 2023; 24:11927. [PMID: 37569299 PMCID: PMC10418868 DOI: 10.3390/ijms241511927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
Aside from their key protective roles in hemostasis and innate immunity, platelets are now recognized as having multifaceted, adverse roles in the pathogenesis, progression and outcome of many types of human malignancy. The most consistent and compelling evidence in this context has been derived from the notable association of elevated circulating platelet counts with the onset and prognosis of various human malignancies, particularly lung cancer, which represents the primary focus of the current review. Key topics include an overview of the association of lung cancer with the circulating platelet count, as well as the mechanisms of platelet-mediated, pro-tumorigenic immunosuppression, particularly the role of transforming growth factor beta 1. These issues are followed by a discussion regarding the pro-tumorigenic role of platelet-derived microparticles (PMPs), the most abundant type of microparticles (MPs) in human blood. In this context, the presence of increased levels of PMPs in the blood of lung cancer patients has been associated with tumor growth, invasion, angiogenesis and metastasis, which correlate with disease progression and decreased survival times. The final section of the review addresses, firstly, the role of cancer-related platelet activation and thrombosis in the pathogenesis of secondary cardiovascular disorders and the associated mortality, particularly in lung cancer, which is second only to disease progression; secondly, the review addresses the potential role of antiplatelet agents in the adjunctive therapy of cancer.
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Affiliation(s)
- Ronald Anderson
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (B.L.R.); (H.C.S.); (A.J.T.)
| | - Bernardo L. Rapoport
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (B.L.R.); (H.C.S.); (A.J.T.)
- The Medical Oncology Centre of Rosebank, Johannesburg 2196, South Africa
| | - Helen C. Steel
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (B.L.R.); (H.C.S.); (A.J.T.)
| | - Annette J. Theron
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa; (B.L.R.); (H.C.S.); (A.J.T.)
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10
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Cranfield BM, Abel GA, Swann R, Moore SF, McPhail S, Rubin GP, Lyratzopoulos G. Pre-Referral Primary Care Blood Tests and Symptom Presentation before Cancer Diagnosis: National Cancer Diagnosis Audit Data. Cancers (Basel) 2023; 15:3587. [PMID: 37509248 PMCID: PMC10377509 DOI: 10.3390/cancers15143587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Blood tests can support the diagnostic process in primary care. Understanding how symptomatic presentations are associated with blood test use in patients subsequently diagnosed with cancer can help to benchmark current practices and guide interventions. METHODS English National Cancer Diagnosis Audit data on 39,751 patients with incident cancer in 2018 were analysed. The frequency of four generic (full blood count, urea and electrolytes, liver function tests, and inflammatory markers) and five organ-specific (cancer biomarkers (PSA or CA125), serum protein electrophoresis, ferritin, bone profile, and amylase) blood tests was described for a total of 83 presenting symptoms. The adjusted analysis explored variation in blood test use by the symptom-positive predictive value (PPV) group. RESULTS There was a large variation in generic blood test use by presenting symptoms, being higher in patients subsequently diagnosed with cancer who presented with nonspecific symptoms (e.g., fatigue 81% or loss of appetite 79%), and lower in those who presented with alarm symptoms (e.g., breast lump 3% or skin lesion 1%). Serum protein electrophoresis (reflecting suspicion of multiple myeloma) was most frequently used in cancer patients who presented with back pain (18%), and amylase measurement (reflecting suspicion of pancreatic cancer) was used in those who presented with upper abdominal pain (14%). Prostate-specific antigen (PSA) use was greatest in men with cancer who presented with lower urinary tract symptoms (88%), and CA125 in women with cancer who presented with abdominal distention (53%). Symptoms with PPV values between 2.00-2.99% were associated with greater test use (64%) compared with 52% and 51% in symptoms with PPVs in the 0.01-0.99 or 1.00-1.99% range and compared with 42% and 31% in symptoms with PPVs in either the 3.00-4.99 or ≥5% range (p < 0.001). CONCLUSIONS Generic blood test use reflects the PPV of presenting symptoms, and the use of organ-specific tests is greater in patients with symptomatic presentations with known associations with certain cancer sites. There are opportunities for greater blood test use in patients presenting with symptoms that do not meet referral thresholds (i.e., <3% PPV for cancer) where information gain to support referral decisions is likely greatest. The findings benchmark blood test use in cancer patients, highlighting opportunities for increasing use.
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Affiliation(s)
- Ben M. Cranfield
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK;
| | - Gary A. Abel
- University of Exeter Medical School, St Luke’s Campus, Exeter EX1 2HZ, UK
| | - Ruth Swann
- National Disease Registration Service, NHS England, Leeds LS1 4AP, UK
- Cancer Research UK, London E20 1JQ, UK
| | - Sarah F. Moore
- University of Exeter Medical School, St Luke’s Campus, Exeter EX1 2HZ, UK
| | - Sean McPhail
- National Disease Registration Service, NHS England, Leeds LS1 4AP, UK
| | - Greg P. Rubin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 4LP, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK;
- National Disease Registration Service, NHS England, Leeds LS1 4AP, UK
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11
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Christakoudi S, Tsilidis KK, Evangelou E, Riboli E. Sex differences in the associations of body size and body shape with platelets in the UK Biobank cohort. Biol Sex Differ 2023; 14:12. [PMID: 36814334 PMCID: PMC9945692 DOI: 10.1186/s13293-023-00494-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Obesity is accompanied by low-grade inflammation and leucocytosis and increases the risk of venous thromboembolism. Associations with platelet count, however, are unclear, because several studies have reported positive associations only in women. Associations with body shape are also unclear, because waist and hip circumferences reflect overall body size, as well as body shape, and are correlated strongly positively with body mass index (BMI). METHODS We evaluated body shape with the allometric body shape index (ABSI) and hip index (HI), which reflect waist and hip size among individuals with the same weight and height and are uncorrelated with BMI. We examined the associations of BMI, ABSI, and HI with platelet count, mean platelet volume (MPV), and platelet distribution width (PDW) in multivariable linear regression models for 125,435 UK Biobank women and 114,760 men. We compared men with women, post-menopausal with pre-menopausal women, and older (≥ 52 years) with younger (< 52 years) men. RESULTS BMI was associated positively with platelet count in women, more strongly in pre-menopausal than in post-menopausal, and weakly positively in younger men but strongly inversely in older men. Associations of BMI with platelet count were shifted towards the inverse direction for daily alcohol consumption and current smoking, resulting in weaker positive associations in women and stronger inverse associations in men, compared to alcohol ≤ 3 times/month and never smoking. BMI was associated inversely with MPV and PDW in pre-menopausal women but positively in post-menopausal women and in men. ABSI was associated positively with platelet count, similarly in women and men, while HI was associated weakly inversely only in women. ABSI was associated inversely and HI positively with MPV but not with PDW and only in women. Platelet count was correlated inversely with platelet size and positively with leucocyte counts, most strongly with neutrophils. CONCLUSIONS Competing factors determine the associations of BMI with platelet count. Factors with sexually dimorphic action (likely thrombopoietin, inflammatory cytokines, or cortisol), contribute to a positive association, more prominently in women than in men, while age-dependent factors (likely related to liver damage and fibrosis), contribute to an inverse association, more prominently in men than in women.
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Affiliation(s)
- Sofia Christakoudi
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK. .,Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, London, UK.
| | - Konstantinos K. Tsilidis
- grid.7445.20000 0001 2113 8111Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk Place, London, W2 1PG UK ,grid.9594.10000 0001 2108 7481Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Evangelos Evangelou
- grid.7445.20000 0001 2113 8111Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk Place, London, W2 1PG UK ,grid.9594.10000 0001 2108 7481Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Elio Riboli
- grid.7445.20000 0001 2113 8111Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk Place, London, W2 1PG UK
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12
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Cranfield BM, Koo MM, Abel GA, Swann R, McPhail S, Rubin GP, Lyratzopoulos G. Primary care blood tests before cancer diagnosis: National Cancer Diagnosis Audit data. Br J Gen Pract 2023; 73:e95-e103. [PMID: 36253112 PMCID: PMC9591015 DOI: 10.3399/bjgp.2022.0265] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/07/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Blood tests can support the diagnostic process in patients with cancer but how often they are used is unclear. AIM To explore use of common blood tests before cancer diagnosis in primary care. DESIGN AND SETTING English National Cancer Diagnosis Audit data on 39 752 patients with cancer diagnosed in 2018. METHOD Common blood test use (full blood count [FBC], urea and electrolytes [U&E], and liver function tests [LFTs]), variation by patient and symptom group, and associations with the primary care interval and the diagnostic interval were assessed. RESULTS At least one common blood test was used in 41% (n = 16 427/39 752) of patients subsequently diagnosed with cancer. Among tested patients, (n = 16 427), FBC was used in 95% (n = 15 540), U&E in 89% (n = 14 555), and LFTs in 76% (n = 12 414). Blood testing was less common in females (adjusted odds ratio versus males: 0.92, 95% confidence interval [CI] = 0.87 to 0.98) and Black and minority ethnic patients (0.89, 95% CI = 0.82 to 0.97 versus White), and more common in older patients (1.12, 95% CI = 1.06 to 1.18 for ≥70 years versus 50-69 years). Test use varied greatly by cancer site (melanoma 2% [ n = 55/2297]; leukaemia 84% [ n = 552/661]). Fewer patients presenting with alarm symptoms alone were tested (24% [ n = 3341/13 778]) than those with non-alarm symptoms alone (50% [ n = 8223/16 487]). Median primary care interval and diagnostic interval were longer in tested than non-tested patients (primary care interval: 10 versus 0 days; diagnostic interval: 49 versus 32 days, respectively, P<0.001 for both), including among tested patients with alarm symptoms (primary care interval: 4 versus 0 days; diagnostic interval: 41 versus 22 days). CONCLUSION Two-fifths of patients subsequently diagnosed with cancer have primary care blood tests as part of their diagnostic process. Given variable test use, research is needed on the clinical context in which blood tests are ordered.
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Affiliation(s)
| | | | - Gary A Abel
- University of Exeter Medical School, St Luke's Campus, Exeter
| | - Ruth Swann
- National Disease Registration Service, NHS Digital, Leeds, and Cancer Research UK, London
| | - Sean McPhail
- National Disease Registration Service, NHS Digital, Leeds
| | - Greg P Rubin
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne
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13
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Ferguson K, Kalia H, Abd-Elsayed A. Approach to Low Back Pain and Peripheral Nerve Stimulation. PERIPHERAL NERVE STIMULATION 2023:236-239. [DOI: 10.1016/b978-0-323-83007-2.00035-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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14
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Rafiq M, Abel G, Renzi C, Lyratzopoulos G. Inflammatory marker testing in primary care in the year before Hodgkin lymphoma diagnosis: a UK population-based case-control study in patients aged ≤50 years. Br J Gen Pract 2022; 72:e546-e555. [PMID: 35817582 PMCID: PMC9282809 DOI: 10.3399/bjgp.2021.0617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/04/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Proinflammatory conditions are associated with increased risk of Hodgkin lymphoma, although the neoplastic process per se often induces an inflammatory response. AIM To examine pre-diagnostic inflammatory marker test use to identify changes that may define a 'diagnostic window' for potential earlier diagnosis. DESIGN AND SETTING This was a matched case-control study in UK primary care using Clinical Practice Research Datalink data (2002-2016). METHOD Primary care inflammatory marker test use and related findings were analysed in 839 Hodgkin lymphoma patients and 5035 controls in the year pre-diagnosis. Poisson regression models were used to calculate monthly testing rates to examine changes over time in test use. Longitudinal trends in test results and the presence/absence of 'red-flag' symptoms were examined. RESULTS In patients with Hodgkin lymphoma, 70.8% (594/839) had an inflammatory marker test in the year pre-diagnosis versus 16.2% (816/5035) of controls (odds ratio 13.7, 95% CI = 11.4 to 16.5, P<0.001). The rate of inflammatory marker testing and mean levels of certain inflammatory marker results increased progressively during the year pre-diagnosis in Hodgkin lymphoma patients while remaining stable in controls. Among patients with Hodgkin lymphoma with a pre-diagnostic test, two-thirds (69.5%, 413/594) had an abnormal result and, among these, 42.6% (176/413) had no other 'red-flag' presenting symptom/sign. CONCLUSION Increases in inflammatory marker requests and abnormal results occur in many patients with Hodgkin lymphoma several months pre-diagnosis, suggesting this period should be excluded in aetiological studies examining inflammation in Hodgkin lymphoma development, and that a diagnostic time window of appreciable length exists in many patients with Hodgkin lymphoma, many of whom have no other red-flag features.
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Affiliation(s)
- Meena Rafiq
- Institute of Epidemiology and Health Care, UCL, London
| | - Gary Abel
- University of Exeter Medical School, Exeter
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15
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Reiser E, Pils D, Grimm C, Hoffmann I, Polterauer S, Kranawetter M, Aust S. Defining Models to Classify between Benign and Malignant Adnexal Masses Using Routine Laboratory Parameters. Cancers (Basel) 2022; 14:cancers14133210. [PMID: 35804981 PMCID: PMC9264825 DOI: 10.3390/cancers14133210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary In patients with adnexal masses, classification into benign or malignant tumors is essential for optimal treatment planning, but remains challenging. In the search for new models applicable in a routine clinical setting, we compared classical single parameters to multiparameter predictive models. Abstract Discrimination between benign and malignant adnexal masses is essential for optimal treatment planning, but still remains challenging in a routine clinical setting. In this retrospective study, we aimed to compare albumin as a single parameter to calculate models by analyzing laboratory parameters of 1552 patients with an adnexal mass (epithelial ovarian cancer (EOC): n= 294; borderline tumor of the ovary (BTO): n = 66; benign adnexal mass: n = 1192) undergoing surgery. Models comprising classical laboratory parameters show better accuracies (AUCs 0.92–0.93; 95% CI 0.90–0.95) compared to the use of single markers, and could easily be implemented in clinical practice by containing only readily available markers. This has been incorporated into a nomogram.
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Affiliation(s)
- Elisabeth Reiser
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Correspondence: (E.R.); (C.G.)
| | - Dietmar Pils
- Division of Visceral Surgery, Department of General Surgery, Comprehensive Cancer Center (CCC), Medical University of Vienna, 1090 Vienna, Austria;
| | - Christoph Grimm
- Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer Center (CCC), Medical University of Vienna, 1090 Vienna, Austria; (I.H.); (S.P.); (M.K.); (S.A.)
- Correspondence: (E.R.); (C.G.)
| | - Ines Hoffmann
- Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer Center (CCC), Medical University of Vienna, 1090 Vienna, Austria; (I.H.); (S.P.); (M.K.); (S.A.)
| | - Stephan Polterauer
- Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer Center (CCC), Medical University of Vienna, 1090 Vienna, Austria; (I.H.); (S.P.); (M.K.); (S.A.)
| | - Marlene Kranawetter
- Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer Center (CCC), Medical University of Vienna, 1090 Vienna, Austria; (I.H.); (S.P.); (M.K.); (S.A.)
| | - Stefanie Aust
- Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer Center (CCC), Medical University of Vienna, 1090 Vienna, Austria; (I.H.); (S.P.); (M.K.); (S.A.)
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16
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Hu L, Liu J, Shimada H, Ito M, Sugimoto K, Hiwasa T, Zhou Q, Li J, Shen S, Wang H. Serum Anti-BRAT1 is a Common Molecular Biomarker for Gastrointestinal Cancers and Atherosclerosis. Front Oncol 2022; 12:870086. [PMID: 35656505 PMCID: PMC9152111 DOI: 10.3389/fonc.2022.870086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/05/2022] [Indexed: 12/23/2022] Open
Abstract
Atherosclerosis (AS) and cancers are major global causes of mortality and morbidity. They also share common modifiable pathogenesis risk factors. As the same strategies used to predict AS could also detect certain cancers, we sought novel serum antibody biomarkers of cancers in atherosclerotic sera sampled by liquid biopsy. Using serological antigen identification by cDNA expression cloning (SEREX) and western blot, we screened and detected the antigens BRCA1-Associated ATM Activator 1 (BRAT1) and WD Repeat Domain 1 (WDR1) in the sera of patients with transient ischemic attacks (TIA). Amplified luminescence proximity homogeneous assay-linked immunosorbent assay (AlphaLISA) established the upregulation of serum BRAT1 antibody (BRAT1-Abs) and WDR1 antibody (WDR1-Abs) in patients with AS-related diseases compared with healthy subjects. ROC and Spearman’s correlation analyses showed that BRAT1-Abs and WDR1-Abs could detect AS-related diseases. Thus, serum BRAT1-Abs and WDR1-Abs are potential AS biomarkers. We used online databases and AlphaLISA detection to compare relative antigen and serum antibody expression and found high BRAT1 and BRAT1-Abs expression in patients with GI cancers. Significant increases (> 0.6) in the AUC for BRAT1-Ab vs. esophageal squamous cell carcinoma (ESCC), gastric cancer, and colorectal cancer suggested that BRAT1-Ab exhibited better predictive potential for GI cancers than WDR1-Ab. There was no significant difference in overall survival (OS) between BRAT1-Ab groups (P = 0.12). Nevertheless, a log-rank test disclosed that the highest serum BRAT1-Ab levels were associated with poor ESCC prognosis at 5–60 weeks post-surgery. We validated the foregoing conclusions by comparing serum BRAT1-Ab and WDR1-Ab levels based on the clinicopathological characteristics of the patients with ESCC. Multiple statistical approaches established a correlation between serum BRAT1-Ab levels and platelet counts. BRAT1-Ab upregulation may enable early detection of AS and GI cancers and facilitate the delay of disease progression. Thus, BRAT1-Ab is a potential antibody biomarker for the diagnosis of AS and GI cancers and strongly supports the routine clinical application of liquid biopsy in chronic disease detection and diagnosis.
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Affiliation(s)
- Liubing Hu
- Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.,The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, China.,College of Life Science and Technology, Jinan University, Guangzhou, China
| | - Jiyue Liu
- Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Anesthesiology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Hideaki Shimada
- Department of Gastroenterological Surgery and Clinical Oncology, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Masaaki Ito
- Department of Gastroenterological Surgery and Clinical Oncology, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Kazuo Sugimoto
- Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Takaki Hiwasa
- Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Qinghua Zhou
- The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, China.,College of Life Science and Technology, Jinan University, Guangzhou, China
| | - Jianshuang Li
- The Biomedical Translational Research Institute, Faculty of Medical Science, Jinan University, Guangzhou, China.,College of Life Science and Technology, Jinan University, Guangzhou, China
| | - Si Shen
- Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Radiology, Medical Imaging Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Hao Wang
- Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Anesthesiology, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Biochemistry and Genetics, Graduate School of Medicine, Chiba University, Chiba, Japan
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17
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Mezei T, Bőde I, Tenke P, Jósa V, Merkel K, Szilasi Z, Tordai A, Máthé D, Baranyai Z. The Correlation Between Platelet Count and Survival in Prostate Cancer. Res Rep Urol 2022; 14:193-202. [PMID: 35572814 PMCID: PMC9092472 DOI: 10.2147/rru.s359715] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/16/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose A number of studies have confirmed that elevated platelet count accompanying various solid tumours is associated with worse survival. However, only meagre data are available on the relationship between thrombocytosis and survival in prostate cancer. Methods We conducted a retrospective analysis on clinical-pathological data accumulated from 316 patients during on average 51 months of follow-up after laparoscopic prostatectomy performed for prostate cancer. We analyzed the relationship between platelet count, risk factors, prostate-specific antigen (PSA) and cancer stage with use the Tumor, Node, Metastase system (TNM), as well as surgical margin, and prognosis. Results Thrombocytosis occurred in only one out of the 316 patients. The multivariate Cox proportional hazard model showed that preoperative PSA, risk group, preoperative haemoglobin level, and surgical margin status were significant, independent predictors of biochemical progression-free survival. By contrast, age at diagnosis and thrombocytosis had no such predictive value. Conclusion We could not demonstrate an association between elevated platelet count and worse survival in our study population of patients with prostate cancer.
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Affiliation(s)
- Tünde Mezei
- Department of Urology, Jahn Ferenc South-Pest Hospital, Budapest, Hungary
- Correspondence: Tünde Mezei, Jahn Ferenc South-Pest Hospital, Department of Urology, Budapest, Hungary, Köves str 1, Budapest, 1204, Hungary, Tel +3620/2013038, Email
| | - Imre Bőde
- Department of Urology, Jahn Ferenc South-Pest Hospital, Budapest, Hungary
| | - Péter Tenke
- Department of Urology, Jahn Ferenc South-Pest Hospital, Budapest, Hungary
| | - Valéria Jósa
- Department of Otorhinolaryngology and Head and Neck Surgery, Jahn Ferenc South-Pest Hospital, Budapest, Hungary
| | | | - Zsuzsanna Szilasi
- Department of Otorhinolaryngology and Head and Neck Surgery, HDF Medical Centre, Budapest, Hungary
| | - Attila Tordai
- Institute of Pathophysiology, Semmelweis University, Budapest, Hungary
| | - Domokos Máthé
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Zsolt Baranyai
- Semmelweis University, Department of Transplantation and Surgery, Budapest, Hungary
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18
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Pre-diagnostic clinical features and blood tests in patients with colorectal cancer: a retrospective linked data study. Br J Gen Pract 2022; 72:e556-e563. [PMID: 35667682 PMCID: PMC9183460 DOI: 10.3399/bjgp.2021.0563] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/21/2022] [Indexed: 10/31/2022] Open
Abstract
Background: The majority of colorectal cancer cases are diagnosed following symptomatic presentation in the United Kingdom. Aim: To identify windows of opportunity for timely investigations or referrals in patients presenting with colon and rectal cancer-relevant symptoms or abnormal blood tests. Design and setting: Retrospective cohort study using linked primary care and cancer registry data of colorectal cancer patients diagnosed in England between 2012-2015. Methods: Monthly consultation rates for relevant clinical features (change in bowel habit, rectal bleeding, abdominal pain, mass, constitutional symptoms, and other bowel symptoms) and abnormal blood test results (low haemoglobin, high platelets and inflammatory markers) up to 24 months pre-diagnosis were calculated. Poisson regression adjusted for age, sex and relevant comorbidities was used to estimate the most likely month when consultation rates increased above baseline trend. Results: 5033 colon and 2516 rectal cancer patients were included. Consultations for all examined clinical features and abnormal blood tests increased in the year pre-diagnosis. Rectal bleeding was the earliest clinical feature to increase from baseline rate: 10 months (95%CI 8.3-11.7) pre-diagnosis for colon cancer; 8 months (95%CI 6.1-9.9) for rectal cancer. Low haemoglobin, high platelets and inflammatory markers increased from as early as 9 months pre-diagnosis. Conclusion: Our study found evidence for early increase in rates of consultation for relevant clinical features and abnormal blood tests in patients with colorectal cancer, suggesting that earlier instigation of cancer-specific investigations or referrals may be warranted in some symptomatic patients.
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19
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Giannakeas V, Kotsopoulos J, Cheung MC, Rosella L, Brooks JD, Lipscombe L, Akbari MR, Austin PC, Narod SA. Analysis of Platelet Count and New Cancer Diagnosis Over a 10-Year Period. JAMA Netw Open 2022; 5:e2141633. [PMID: 35015064 PMCID: PMC8753503 DOI: 10.1001/jamanetworkopen.2021.41633] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Individuals with cancer often have an elevated platelet count at the time of diagnosis. The extent to which an elevated platelet count is an indicator of cancer is unclear. OBJECTIVE To evaluate the association of an elevated platelet count with a cancer diagnosis. DESIGN, SETTING, AND PARTICIPANTS This nested case-control study included Ontario residents enrolled in the provincial health insurance plan who had 1 or more routine complete blood count (CBC) tests performed between January 1, 2007, and December 31, 2017, with follow-up through December 31, 2018. Case patients were individuals with a new cancer diagnosis during the observation period. Eligible control individuals were cancer free before the date of diagnosis for a case patient to whom they were matched. One case patient was matched to 3 controls based on sex, age, and health care use patterns. Data were analyzed from September 24, 2020, to July 13, 2021. EXPOSURES Case patients and controls were assigned to 1 of 5 exposure groups based on age- and sex-specific platelet count distributions in the control population: very low (≤10th percentile), low (>10th to 25th percentile), medium (>25th to <75th percentile), high (75th to <90th percentile), and very high (≥90th percentile). MAIN OUTCOMES AND MEASURES Odds ratios (ORs) were estimated for specific cancer sites for each category of platelet count at intervals up to 10 years after a blood test. RESULTS Of the 8 917 187 eligible Ontario residents with a routine CBC record available, 4 971 578 (55.8%) were women; the median age at the first CBC was 46.4 years (IQR, 32.5-59.5 years). Among individuals with a routine CBC record available, 495 341 (5.6%) received a diagnosis of first primary cancer during the 10-year observation period. The OR for a solid tumor diagnosis associated with a very high platelet count vs a medium platelet count in the 6-month period before the diagnosis was 2.32 (95% CI, 2.28-2.35). A very high platelet count was associated with colon (OR, 4.38; 95% CI, 4.22-4.54), lung (OR, 4.37; 95% CI, 4.22-4.53), ovarian (OR, 4.62; 95% CI, 4.19-5.09), and stomach (OR, 4.27; 95% CI, 3.91-4.66) cancers. Odds ratios attenuated with increasing time from CBC test to cancer diagnosis. CONCLUSIONS AND RELEVANCE In this nested case-control study, an elevated platelet count was associated with increased risk of cancer at several sites. Our findings suggest that an elevated platelet count could potentially serve as a marker for the presence of some cancer types.
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Affiliation(s)
- Vasily Giannakeas
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Joanne Kotsopoulos
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Matthew C. Cheung
- ICES, Toronto, Ontario, Canada
- Division of Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Laura Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer D. Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lorraine Lipscombe
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, Women’s College Hospital, Toronto, Ontario, Canada
| | - Mohammad R. Akbari
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Peter C. Austin
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Steven A. Narod
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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20
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Zhou Y, Walter FM, Mounce L, Abel GA, Singh H, Hamilton W, Stewart GD, Lyratzopoulos G. Identifying opportunities for timely diagnosis of bladder and renal cancer via abnormal blood tests: a longitudinal linked data study. Br J Gen Pract 2022; 72:e19-e25. [PMID: 34903517 PMCID: PMC8714503 DOI: 10.3399/bjgp.2021.0282] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/14/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Understanding pre-diagnostic test use could reveal diagnostic windows where more timely evaluation for cancer may be indicated. AIM To examine pre-diagnostic patterns of results of abnormal blood tests in patients with bladder and renal cancer. DESIGN AND SETTING A retrospective cohort study using primary care and cancer registry data on patients with bladder and renal cancer who were diagnosed between April 2012 and December 2015 in England. METHOD The rates of patients with a first abnormal result in the year before cancer diagnosis, for 'generic' (full blood count components, inflammatory markers, and calcium) and 'organ-specific' blood tests (creatinine and liver function test components) that may lead to subsequent detection of incidental cancers, were examined. Poisson regression was used to detect the month during which the cohort's rate of each abnormal test started to increase from baseline. The proportion of patients with a test found in the first half of the diagnostic window was examined, as these 'early' tests might represent opportunities where further evaluation could be initiated. RESULTS Data from 4533 patients with bladder and renal cancer were analysed. The monthly rate of patients with a first abnormal test increased towards the time of cancer diagnosis. Abnormalities of both generic (for example, high inflammatory markers) and organ-specific tests (for example, high creatinine) started to increase from 6-8 months pre-diagnosis, with 25%-40% of these patients having an abnormal test in the 'early half' of the diagnostic window. CONCLUSION Population-level signals of bladder and renal cancer can be observed in abnormalities in commonly performed primary care blood tests up to 8 months before diagnosis, indicating the potential for earlier diagnosis in some patients.
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Affiliation(s)
- Yin Zhou
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fiona M Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; professor of primary care cancer research, Wolfson Institute of Population Health, Queen Mary University London, London, UK
| | - Luke Mounce
- University of Exeter Medical School, Exeter, UK
| | - Gary A Abel
- University of Exeter Medical School, Exeter, UK
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, US; Baylor College of Medicine, Houston, TX, US
| | | | - Grant D Stewart
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes, Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
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21
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Abstract
IMPORTANCE Individuals with newly diagnosed cancer often have a high platelet count (thrombocytosis). Whether thrombocytosis is associated with the presence of an undiagnosed cancer remains unknown. OBJECTIVE To assess whether a new diagnosis of thrombocytosis is associated with a subsequent risk of cancer among adults. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study was conducted using linked laboratory data from Ontario, Canada, from January 1, 2007, to December 31, 2017, with follow-up until December 31, 2018. The study cohort included adults aged 40 to 75 years on the date of a routine complete blood count (CBC) test (index test) who had a normal platelet count in the 2 previous years and no history of cancer. Data analysis was performed in December 2020. EXPOSURES Exposed individuals were those with a platelet count greater than 450 × 109/L. Matched unexposed control individuals had a platelet count within the reference range (150 × 109/L to 450 × 109/L) reported within 30 days of the exposure. MAIN OUTCOMES AND MEASURES Incident cancers within 5 years after diagnosis of thrombocytosis. Absolute and relative risks for cancer associated with thrombocytosis were estimated for all cancers and for cancers at specific sites. RESULTS Of the 3 386 716 Ontario residents with a recorded routine CBC test result, 53 339 (1.6%) had thrombocytosis and a prior normal platelet count. Among individuals with thrombocytosis, the median age was 59.7 years (interquartile range, 50.2-67.4 years) and 37 349 (70.0%) were women. Among the 51 624 individuals with thrombocytosis included in the matched analysis, 2844 (5.5%) had received a diagnosis of a solid cancer in the 2-year follow-up period and 3869 (7.5%) had received a diagnosis within 5 years. The relative risk (RR) for developing any solid cancer within 2 years was 2.67 (95% CI, 2.56-2.79). Associations were found between thrombocytosis and cancers of the ovary (RR, 7.11; 95% CI, 5.59-9.03), stomach (RR, 5.53; 95% CI, 4.12-7.41), colon (RR, 5.41; 95% CI, 4.80-6.10), lung (RR, 4.41; 95% CI, 4.02-4.85), kidney (RR, 3.64; 95% CI, 2.94-4.51), and esophagus (RR, 3.64; 95% CI, 2.46-5.40). CONCLUSIONS AND RELEVANCE In this cohort study, an increased platelet count was associated with an increased risk of cancer for at least 2 years. The results suggest that individuals with unexplained thrombocytosis should be offered screening for several cancers.
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Affiliation(s)
- Vasily Giannakeas
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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22
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Interpreting negative test results when assessing cancer risk in general practice. Br J Gen Pract 2021; 71:298-299. [PMID: 34319881 PMCID: PMC8249029 DOI: 10.3399/bjgp21x716189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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