Prognostic impact of thrombocytosis in gastric cancer-A retrospective study

BACKGROUND

Solid tumors are a common cause of secondary thrombocytosis, which has been identified as a prognostic factor in various cancers. However, the impact of thrombocytosis on the prognosis of gastric cancer is not yet well defined. The aim of this study was to assess the prevalence and prognostic value of thrombocytosis in patients with gastric cancer.

METHODS

This was a retrospective study of patients with gastric carcinoma treated surgically, with curative intent, in our hospital, Centro Hospitalar Vila Nova de Gaia/Espinho, between January 2009 and December 2019. Clinical files were consulted and clinicopathological characteristics were analyzed.

RESULTS

In the present sample (n = 352), the prevalence of pretreatment thrombocytosis was 16.5%. Thrombocytosis was associated with more advanced T stage, greater number of metastatic nodes, and more frequent lymphatic and venous permeation. The presence of thrombocytosis had a negative impact on disease-free survival (hazard ratio [HR] 3.54, 95% confidence interval [CI] 2.35-5.33, P < .001) and overall survival (HR 4.45, 95% CI 2.95-6.71, P < .001).

CONCLUSIONS

The presence of pretreatment thrombocytosis had a negative impact on overall survival and disease-free survival and thus could be used as an independent prognostic factor.

Bidirectional Interaction Between Cancer Cells and Platelets Provides Potential Strategies for Cancer Therapies

Platelets are essential components in the tumor microenvironment. For decades, clinical data have demonstrated that cancer patients have a high risk of thrombosis that is associated with adverse prognosis and decreased survival, indicating the involvement of platelets in cancer progression. Increasing evidence confirms that cancer cells are able to induce production and activation of platelets. Once activated, platelets serve as allies of cancer cells in tumor growth and metastasis. They can protect circulating tumor cells (CTCs) against the immune system and detachment-induced apoptosis while facilitating angiogenesis and tumor cell adhesion and invasion. Therefore, antiplatelet agents and platelet-based therapies should be developed for cancer treatment. Here, we discuss the mechanisms underlying the bidirectional cancer-platelet crosstalk and platelet-based therapeutic approaches.

Decreased mean platelet volume is associated with microsatellite instability in colorectal cancer: A propensity score-matched analysis

BACKGROUND

Patients with microsatellite instability-high (MSI-H) colorectal cancer (CRC) generally have a better prognosis and a more effective immune response than patients with microsatellite stable (MSS) CRC. Moreover, activated platelets play a crucial role in modulating innate immune cells. Mean platelet volume (MPV) is an indicator of platelet activation. This study is to examine the association between MPV and MSI status in CRC.

METHODS

We collected the clinical and pathological variables of 424 CRC patients diagnosed at the Harbin Medical University Cancer Hospital from January 2018 to December 2018. Associations between MPV levels and MSI status were examined. Propensity score matching (PSM) was performed to reduce the possibility of selection bias.

RESULTS

424 CRC patients were divided into low-MPV group and high-MPV group according to the optimal cut-off value of MPV. 131 high-MPV patients were matched to low-MPV counterparts in a 1:1 ratio by propensity score matching. As MPV levels increased, the percentage of patients with MSI-H reduced. Furthermore, compared with MSS group, the MSI-H group had a significantly lower MPV levels (p= 0.003 after matching). In addition, logistic regression analysis identified reduced MPV as an independent risk factor for MSI-H in CRC patients after controlling for other potential parameters.

CONCLUSION

Lower MPV is associated with MSI-H subtype of CRC. Further study on MPV in MSI-H CRC is warranted.

Elevated Platelet Distribution Width Predicts Poor Prognosis in Gallbladder Carcinoma

Background

Previous studies have demonstrated that platelet distribution width (PDW) is a reliable predictor of prognosis of a variety of tumors. Nevertheless, the prognostic value of PDW in gallbladder carcinoma (GBC) remains unknown. We aimed to explore the correlation between PDW and prognosis in patients with GBC.

Methods

A total of 303 patients with GBC who underwent curative surgery between January 2005 and February 2017 were enrolled. The relationship between PDW and clinicopathological features was analyzed. Receiver operating characteristic (ROC) curve was used to identify the optimal cutoff value of PDW. The overall survival (OS) rate was estimated by Kaplan–Meier method. Meanwhile, univariable and multivariable Cox regression model were used to evaluate the risk factors for OS.

Results

There was significant correlation between elevated PDW and AJCC stage. In addition, survival analysis revealed that the patients with PDW>14.95 have a worse prognosis than patients with PDW\documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} $$ \le $$ \end{document}14.95 (P < 0.001). The multivariable Cox regression model analysis demonstrated that PDW was an independent prognostic factor in GBC patients (hazard ratio=1.976, 95% confidence interval:1.474–2.650, P<0.001).

Conclusion

Elevated PDW can predict poor prognosis in GBC patients, and further studies are needed to verify the reliability and clarify the exact molecular mechanistic of PDW in GBC.

Significant difference of c-type lectin-like receptor 2 between colorectal cancer and polyp subgroups

BACKGROUND

Platelets play a key role in tumor progression and metastasis. C-type lectin-like receptor 2 (CLEC-2) is the receptor expressed on platelets and the marker of platelet activation.

OBJECTIVE

This study aims to determine whether soluble CLEC-2 levels differ between patients with benign colorectal polyps and those with colorectal cancer (CRC).

METHODS

We measured plasma soluble CLEC-2 by enzyme-linked immunosorbent assay in 150 patients with colorectal polyps, 150 CRC patients without metastasis, 150 CRC liver metastasis, and 150 control subjects.

RESULTS

The CRC patients had higher soluble CLEC-2 levels than patients with colorectal polyps (p< 0.001). Moreover, CRC patients with liver metastases displayed higher CLEC-2 levels than those in CRC patients without metastases (p< 0.001). In the CRC patients, CLEC-2 levels were correlated with lymph node metastasis and advanced stage. In the patients with polyps, there was a significant difference in CLEC-2 levels among patients with hyperplastic polyp, sessile serrated adenoma, and traditional serrated adenoma (p< 0.001). The ROC curve analysis revealed CLEC-2 had an optimal sensitivity of 77.3% and specificity of 94.6% for the screening of CRC, and sensitivity of 71.0% and specificity of 76.7% for the differential diagnosis of colorectal polyps and CRC.

CONCLUSIONS

CRC patients have higher CLEC-2 levels than patients with colorectal polyps and healthy controls. Moreover, there is a significant difference in CLEC-2 levels among polyp subtypes. Further research is warranted.

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 factors for survival in patients with gastric adenocarcinoma

Background

Gastric cancer ranks as a leading cause of cancer deaths worldwide. Information of prognostic factors related to gastric cancer are limited.

Aim

This study aimed to gather clinical data and prevalence of prognostic factors related to gastric adenocarcinoma in Thailand.

Methods and results

This retrospective cohort study was conducted at Thammasat University Hospital, Thailand between January 2010 and July 2018. Gastric adenocarcinoma patients were enrolled and followed up for at least 5 years. Total of 210 gastric tumor patients were enrolled. One hundred patients were diagnosed with gastric adenocarcinomas (57 men and 43 women, mean age = 61.1 years). The leading presenting symptoms were weight loss (65%), followed by dyspepsia (54%) and UGI bleeding. Common clinical manifestations were thrombocytosis (26%), followed by syndrome of inappropriate antidiuretic hormone (SIADH; 15%). Eosinophilia was present in early cancer (25.0% vs 6.5%, P = .123), while SIADH and thrombocytosis were more common in advanced stages (16.3% vs 0%, P = .602, and 28.3% vs 0%, P = .108, respectively). SIADH was significantly related to reduced 1‐year survival rate compared to normal serum sodium levels (21.4% vs 71.4%, OR 0.109, 95% CI 0.024‐0.497, P = .004). Five‐year survival rates were worse in patients with SIADH, but better in patients with eosinophilia compared to patients without these conditions (0% vs 27.8%, P = .058 and 20.0% vs 7.8%, P = .375, respectively).

Conclusion

Thrombocytosis and SIADH were common in gastric cancer. SIADH was significantly correlated with poor 1‐year survival. These clinical manifestations might be useful for predicting gastric cancer prognosis.

Prognostic Impact of Increased Perioperative Platelet Count in Gastric Cancer Patients

BACKGROUND

Solid tumors are a common cause of secondary (reactive) thrombocytosis, a paraneoplastic syndrome that is also a prognostic factor for various cancers. However, cutoff values for platelet count specific to gastric cancer and their prognostic roles are unknown.

METHODS

We retrospectively analyzed records of 4643 patients with gastric cancer who underwent radical surgery from 2007 to 2010. The minimum P-value approach was used with the log-rank test to determine the optimal prognosis predicting threshold for preoperative platelet count. Change in perioperative platelet count over time was evaluated with a generalized estimating equation. Clinicopathologic features and prognostic significance were analyzed according to platelet count.

RESULTS

Thrombocytosis prevalence (platelet count ≥40 × 10⁴/μL) was 1.6% (75 of 4643 patients). The platelet count cutoff value with the lowest P-value was ≥25.5 × 10⁴/μL, and patients with higher platelet count had more advanced disease. Multivariate analysis showed that cutoff value was an independent prognostic factor of overall survival (hazard ratio 1.19, 95% confidence interval 1.03-1.37, P = 0.017). Patients who underwent adjuvant chemotherapy (n = 1300) and had a greater than 10% increase in platelet count at postoperative 1 y compared to before surgery had significantly poorer overall survival (hazard ratio 1.65, 95% confidence interval 1.11-2.45, P = 0.013).

CONCLUSIONS

Elevated preoperative platelet count (≥25.5 × 10⁴/μL) and increased platelet count (≥10%) at postoperative 1 y in an adjuvant chemotherapy group were unfavorable prognostic factors. Platelet count could be a cost-effective biomarker for screening and monitoring patients with unfavorable survival outcomes.

Prognostic value of the fibrinogen-to-platelet ratio as an inflammatory and coagulative index in patients with gastric cancer

PURPOSE

We assessed the prognostic value of the fibrinogen-to-platelet ratio (FPR) as an inflammatory and coagulative index by examining its clinicopathologic and prognostic efficiency in patients with gastric cancer (GC).

METHODS

The subjects of this retrospective study were 182 GC patients whose FPR was measured preoperatively between January, 2001 and December, 2006. The FPR was defined as the plasma fibrinogen divided by the platelet counts.

RESULTS

Patients aged ≥ 65 years and with venous invasion had a significantly higher FPR (p = 0.02 and p < 0.01, respectively) than those aged < 65 years and without venous invasion. We found a correlation between the FPR and all recurrences (p < 0.01). Patients with a low FPR had significantly better overall survival (OS) and relapse-free survival (RFS) rates than patients with a high FPR (p = 0.001 for both). Furthermore, the FPR was an independent predictor of OS and RFS (p = 0.02 and 0.001, respectively), but the fibrinogen level was not. In a subgroup analysis, the FPR was a significant prognostic factor for OS and RFS in patients with pathological stages II/III disease and in patients aged < 65 years.

CONCLUSION

The FPR can be calculated easily and is more useful than the fibrinogen level for predicting the prognosis of GC patients. Patients with a high FPR, particularly those with undifferentiated tumors, those with pStage II/III disease, and those aged < 65 years, require more intensive chemotherapy.

Platelet indices in laryngeal cancer

BACKGROUND

Laryngeal cancer is one of the most common malignancies in the head and neck. Activated platelets play a critical role in cancer development and progression. Altered mean platelet volume (MPV) and platelet distribution width (PDW) have been found in various types of cancer. The purpose of the current study was to investigate the association of platelet indices with laryngeal cancer.

STUDY DESIGN

The study included 216 patients with laryngeal cancer, 189 subjects with benign laryngeal disease, and 213 control subjects between January 2015 and December 2015. All participants' clinical and laboratory characteristics at initial diagnosis were collected.

RESULT

MPV was significantly lower and PDW was markedly higher in laryngeal cancer patients compared with control subjects and patients with benign laryngeal disease. A significant correlation between MPV and lymph node metastasis was found. The prevalence of laryngeal cancer increased as MPV quartiles decreased and PDW quartiles increased. Furthermore, MPV and PDW were independent risk factors for distinguishing laryngeal cancer from benign laryngeal disease.

CONCLUSIONS

The patients with laryngeal cancer have reduced MPV and increased PDW compared to the subjects without laryngeal cancer. In addition, MPV and PDW play different roles in laryngeal cancer from benign laryngeal disease.

The prognostic role of pretreatment thrombocytosis in gastric cancer: A systematic review and meta-analysis

BACKGROUND

The association between platelet count and the prognosis of patients with gastric cancer has already been reported by numerous studies. As the reports are inconsistent, we conducted this meta-analysis to evaluate the prognostic significance of platelet count in patients with gastric cancer.

METHODS

A comprehensive search was performed in PubMed, Embase, and the Cochrane Library to identify relevant studies, which evaluated the prognostic impact of pretreatment platelet count in patients with gastric cancer. Data was pooled using a random effect model to calculate hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

Around 10 studies were included, comprising 8166 patients in total. The result showed that patients with thrombocytosis had significant worse overall survival (HR 1.57, 95% CI 1.36-1.81, P < .001) than those with normal platelet count, and were associated with advanced clinical stage (OR, 1.57; 95% CI, 1.15-2.13; P = .004), deeper tumor invasion (OR,3.49; 95% CI, 2.48-4.91; P < .001), and higher risk of recurrence (OR, 2.28; 95% CI, 1.55-3.35; P < .001).

CONCLUSION

Pretreatment thrombocytosis is a potential effective predictor of overall survival (OS) for patients with gastric cancer and is correlated with higher risks of recurrence, serosal invasion, and advanced stage.

The Combination of Seven Preoperative Markers for Predicting Patients with Gastric Cancer to Be Either Stage IV or Non-Stage IV

To assess whether preoperative markers could predict the stage of patients with gastric cancer. We analyzed retrospectively the preoperative indicators between stage IV and non-stage IV gastric cancer at the Gastrointestinal Surgery of Nanjing Drum Tower Hospital. A total of 500 patients with gastric cancer were screened. Of all the variables, alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 125, carbohydrate antigen (CA) 199, carbohydrate antigen (CA) 724, carbohydrate antigen (CA) 242, thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), blood platelet count (PLT), white blood cell (WBC) count, C-reactive protein (CRP), neutrophil count (NC), lymphocyte count (LC), neutrophil-lymphocyte ratio (NLR), hemoglobin (HB), aspartate aminotransferase (AST), and ascites were found to have statistical differences between the two groups. Then, Stepwise Discriminant Analysis was conducted to establish a prediction model including 7 indexes (CA724, CA242, TT, PLT, CRP, AST, and ascites). According to the model, 90.6% of original grouped cases were correctly classified and 90.6% of cross-validated grouped cases were correctly classified. We built a discriminant including CA724, CA242, TT, PLT, CRP, AST, and ascites for predicting patients with gastric cancer to be either stage IV or non-stage IV. According to this discriminant, 90.6% of patients could be correctly predicted.

Prognostic role of multidrug resistance-associated protein 1 expression and platelet count in operable non-small cell lung cancer

The overall survival rate of patients with non-small cell lung cancer (NSCLC) following resection remains poor due to the high rates of recurrence and metastasis. The investigation of novel biomarkers is clinically necessary to improve treatment strategies. Multidrug resistance-associated protein 1 (MRP1) and platelet count are linked to a poor prognosis in various types of cancer. However, it is unknown whether MRP1 or platelet count is a suitable prognostic indicator of NSCLC. In the present study, 427 patients with operable NSCLC were enlisted. The association of MRP1 expression and platelet count with clinical pathological factors and patient outcome was evaluated. MRP1 expression was found to be significantly associated with sex, histological type and tumor differentiation, while platelet count was significantly associated with smoking behavior, histological type and clinical stage. Platelet count was significantly higher in patients with negative MRP1 expression than in those with positive MRP1 expression. Survival analysis indicated that there was no association between MRP1 expression and disease-free survival (DFS) or overall survival (OS) time. In the patients with no lymph node metastasis, the OS time was significantly longer in patients with positive MRP1 expression than in those with negative expression. However, in the patients with lymph node metastasis, the DFS time was significantly shorter in patients with positive MRP1 expression than in those with negative expression. There was an association between the platelet count and DFS and OS times, which were significantly longer in patients with a normal platelet count than in those with thrombocytosis. In conclusion, MRP1 expression and platelet count are valuable independent prognostic biomarkers for survival in operable NSCLC.

The pretreatment thrombocytosis as one of prognostic factors for gastric cancer: A systematic review and meta-analysis

BACKGROUND & AIMS

At present, increasing reports have shown that pretreatment platelet count was associated with the prognosis of many types of cancer. We performed rounded analysis to comprehensively analyze and evaluate the prognostic significance of pretreatment thrombocytosis for patients with gastric cancer.

METHODS

We identified relevant studies by searching database including PubMed, Embase, Cochrane Library and Web of Science. The relative risk (RR) with its 95% confidence interval (CI) was used to assess the correlation between thrombocytosis and overall survival (OS) of gastric cancer patients. We also conducted subgroup analysis and sensitivity analysis for the prognostic effect of thrombocytosis on OS. The analysis was performed and assessed using Review Manager 5.2.

RESULTS

A total of nine studies including 7158 participants were included in this systematic review. Analysis results showed that pretreatment thrombocytosis had a close relationship with 1, 3 and 5 years survival of gastric cancer, with the pooled RRs being 0.80 (95% CI 0.71-0.90; P = 0.0004), 0.65 (95% CI 0.45-0.92; P = 0.02) and 0.64 (95% CI 0.47-0.87; P = 0.004) respectively.

CONCLUSIONS

The present rounded analysis suggests that pretreatment thrombocytosis may have significant association with poor survival of patients with gastric cancer.

Mean Platelet Volume and Platelet Distribution Width Are Associated with Gallbladder Cancer

Gallbladder cancer (GBC) represents the most common biliary tract malignancy. Activated platelets play an essential role in cancer development and progression. Mean platelet volume (MPV) and platelet distribution width (PDW) are commonly used indexes of activated platelets in clinical practice. The aim of the current study was to investigate the association of MPV and PDW with GBC. 104 GBC patients and 109 normal control subjects were entered in this study between January 2015 and December 2015. We collected all participants’ clinical and laboratory characteristics at initial diagnosis. The odds ratios (ORs) for GBC were calculated using multivariate logistic regression analysis after adjusting for confounding variables across MPV and PDW quartiles. MPV levels were markedly lower and PDW levels were remarkably higher in GBC patients than control subjects. A significant correlation between PDW and lymph node metastasis was detected. In addition, after adjusting for other risk factors, the ORs (95% CIs) for GBC in each MPV quartile were 5.117 (1.939-13.506), 2.444 (0.917-6.516), 3.718 (1.381-10.007), and 1.000, respectively. The ORs (95% CIs) for GBC in each PDW quartile were 1.000, 2.063 (0.825-5.162), 3.070 (1.108-8.507), and 12.108 (4.243-34.553), respectively. In conclusion, decreased MPV and elevated PDW were independently associated with GBC. Our findings suggest that MPV and PDW are available parameters for early detection of GBC.

Decreased Mean Platelet Volume is Associated with Cervical Cancer Development

Background:

Cervical cancer is the most common gynecological malignant disorder worldwide. Activated platelets play a key role in cancer development and progression. Mean platelet volume (MPV) is an early indicator of platelet activation. The aim of the present study was to evaluate MPV levels in patients with cervical cancer.

Materials and methods:

A total of 181 patients with cervical cancer and 181 controls between January 2015 and June 2015 were included in the study. Patient characteristics and hematologic test data at initial diagnosis were collected and odds ratios (ORs) and 95% confidence intervals (CIs) for risk of cervical cancer were calculated using multivariate logistic regression analyses across MPV quartiles.

Results:

MPV levels were decreased in patients with cervical cancer compared with control subjects. A significant correlation between MPV and FIGO stage was found. Moreover, after adjusting for other risk factors, the ORs (95%CIs) for cervical cancer according to MPV quartiles were 4.450 (1.975-10.026), 2.505 (1.206-5.202), 0.573 (0.261-1.259), and 1.000, respectively.

Conclusions:

MPV was found to be independently associated with the presence of cervical cancer. Our results suggest that MPV could be potential diagnostic screening tool.

Association of decreased mean platelet volume with renal cell carcinoma

BACKGROUND

Renal cell carcinoma (RCC) is the third most common genitourinary cancer. Activated platelets play a pivotal role in cancer development and progression. Altered mean platelet volume (MPV) has been reported in several malignancies. The aim of the present study was to investigate the association of MPV with RCC.

STUDY DESIGN

The study consisted of 145 patients with RCC, 110 patients with benign renal tumor and 132 healthy control subjects between January 2015 and December 2015. All participants' clinical and laboratory characteristics at initial diagnosis were collected. The odds ratios (ORs) for RCC were calculated using multivariate logistic regression analysis after adjusting for confounding variables across MPV quartiles.

RESULTS

The patients with RCC had decreased pre-operative MPV compared to the patients with benign renal tumor and healthy control subjects. Furthermore, pre-operative MPV was reduced in benign renal tumor compared with healthy control subjects. Surgical tumor resection resulted in a significant increase in MPV levels (8.7 fL vs. 9.0 fL; p = 0.011). After adjusting for other risk factors, the ORs (95% CIs) for RCC in each MPV quartile were 25.725 (7.556-87.585), 7.447 (2.701-20.537), 0.703 (0.245-2.019), and 1.000, respectively.

CONCLUSIONS

RCC patients have remarkably reduced MPV compared to patients with benign renal tumor and healthy control subjects. Moreover, decreased MPV was independently associated with RCC. Our results suggest that detection of MPV may be useful to assess the risk of RCC.

Platelet distribution width correlates with prognosis of non-small cell lung cancer

Platelets play a multifaceted role in cancer progression and metastasis. Mean platelet volume (MPV) and platelet distribution width (PDW) are commonly used platelet parameters from routine blood test. The aim of the present study was to investigate the correlation between platelet indices and prognosis in patients with non-small cell lung cancer (NSCLC). A total of 270 patients who were diagnosed with NSCLC between January 2009 and December 2009 were retrospectively analyzed. Patients’ characteristics and hematologic tests data at initial diagnosis were collected. The overall survival rate was estimated using Kaplan-Meier method. The prognostic analysis was carried out with univariate and multivariate Cox regressions model. Reduced PDW was significantly correlated with T stage, N stage, TNM stage, and histological type of the disease. Moreover, survival analysis showed that the overall survival of patients with PDW ≥ 16.3% was significantly longer than that of those with PDW < 16.3% (P < 0.001). In multivariate Cox regression model, age, sex, TNM stage, and PDW were identified as independent prognostic factors for overall survival (for PDW, P < 0.001). In conclusion, reduced PDW is an unfavorable predictive factor of NSCLC patient survival. Further studies are warranted.

Clinical significance of coagulation factors in operable colorectal cancer

Abnormal hemostasis in cancer patients has prev iously been studied. The primary objective of the present study was to evaluate the association between preoperative hemostasis markers and clinicopathological parameters, and to identify a hemostasis marker affecting survival in patients following curative resection for colorectal cancer. A total of 170 patients who underwent curative surgery for colorectal carcinoma were evaluated. Preoperative coagulation tests included platelet, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer and fibrinogen degradation product (FDP). The clinicopathological variables, including age, gender, tumor location (rectum/colon), tumor size (≥5 cm vs. <5 cm), depth of tumor invasion, lymph node metastasis, stage, lymphovascular invasion, margin involvement and histological differentiation were analyzed. The median age of analyzed patients was 63 years (range, 28-84). The male to female ratio was 62:38. Increased levels of plasma fibrinogen, PT and platelet count (PLT) were associated with larger tumor size (P<0.001, P=0.015 and P=0.002, respectively). Increased plasma fibrinogen levels were significantly associated with depth of tumor invasion and stage (P=0.014 and P=0.048, respectively). Increased plasma D-dimer and FDP levels were significantly associated with tumor node metastasis stage (P=0.031 and P=0.002, respectively). Prolonged PT level (≥11.7 sec), hyper-fibrinogenemia (≥327 mg/dl), high D-dimer level (≥1.3 µg/ml) and increased FDP level (≥2.7 µg/ml) were the prognostic factors associated with shorter survival. Preoperative plasma fibrinogen level was significantly associated with tumor size and depth of tumor invasion. Preoperative plasma prolonged PT level, hyperfibrinogenemia, high D-dimer level and increased FDP level may function as hemostasis markers that predict overall survival in operable patients with colorectal cancer.

The clinicopathological and prognostic role of thrombocytosis in patients with cancer: A meta-analysis

Previous studies have linked the presence of thrombocytosis with the progression and development of cancer; however, this trend requires further investigation. The present study aimed to derive an estimation of the degree of association between thrombocytosis and the 5-year overall survival rate of patients with cancer, as well as common clinicopathological features, by performing a meta-analysis of 20 (n=12,778) published studies. The PubMed and Embase databases were searched systematically for all relevant articles published in English. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated using a fixed effects or random effects model to evaluate the degree of the observed associations. The results suggested that thrombocytosis (platelet count, >400×10⁹/l) correlated with a decreased 5-year overall survival rate (OR=2.70, 95% CI=2.03-3.61) and an advanced tumor-node-metastasis stage (III + IV; OR=2.14, 95% CI=1.58-2.90). Furthermore, these associations remained robust following stratification of the data by cancer type and ethnicity. In addition, thrombocytosis (platelet count, >300×10⁹/l) correlated with a decreased 5-year overall survival rate in patients with colorectal cancer (OR=3.49, 95% CI=1.44-8.46). Although certain biases were not able to be eliminated, the present meta-analysis suggested that thrombocytosis is a valuable indicator for the evaluation of pathological diagnosis and prognosis for patients with cancer. Further studies are required to investigate the effect of thrombocytosis on the prognosis of patients with cancer.

Prognostic value of preoperative inflammatory response biomarkers in patients with esophageal cancer who undergo a curative thoracoscopic esophagectomy

Background

Several inflammatory response biomarkers, including lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) have been reported to predict survival in various cancers. The aim of this study is to evaluate the clinical value of these biomarkers in patients undergoing curative resection for esophageal cancer.

Methods

The LMR, NLR and PLR were calculated in 147 consecutive patients who underwent esophagectomy between January 2006 and February 2015. We examined the prognostic significance of the LMR, NLR, and PLR in both elderly and non-elderly patients. We evaluated the cancer-specific survival (CSS), with the cause of death determined from the case notes or computerized records.

Results

Univariate analyses demonstrated that TNM pStage (p < 0.0001), tumor size (p = 0.0014), operation time (p = 0.0209), low LMR (p = 0.0008), and high PLR (p = 0.0232) were significant risk factors for poor prognosis. Meanwhile, TNM pStage (p < 0.0001) and low LMR (p = 0.0129) were found to be independently associated with poor prognosis via multivariate analysis.

In non-elderly patients, univariate analyses demonstrated that TNM pStage (p < 0.0001), tumor size (p = 0.0001), operation time (p = 0.0374), LMR (p < 0.0001), and PLR (p = 0.0189) were significantly associated with a poorer prognosis. Multivariate analysis demonstrated that TNM pStage (p = 0.001) and LMR (p = 0.0007) were independent risk factors for a poorer prognosis.

In elderly patients, univariate analysis demonstrated that that TNM pStage (p = 0.0023) was the only significant risk factor for a poor prognosis.

Conclusions

LMR was associated with cancer-specific survival (CSS) of esophageal cancer patients after curative esophagectomy. In particular, a low LMR was a significant and independent predictor of poor survival in non-elderly patients. The LMR was convenient, cost effective, and readily available, and could thus act as markers of survival in esophageal cancer.

Prognostic value of hematological parameters in patients undergoing esophagectomy for esophageal squamous cell carcinoma

Background

It is now widely recognized that outcomes in cancer patients are not determined by their tumor characteristics alone. In this study, we retrospectively analyzed the clinical data of esophageal cancer patients to evaluate the impact of red blood cell distribution width (RDW), platelet distribution width (PDW), and mean platelet volume (MPV) on cancer-specific survival (CSS).

Study design

We retrospectively reviewed a database of 144 consecutive patients who underwent curative esophagectomy for esophageal squamous cell carcinoma at our institute between 2006 and 2014.

Result

In multivariate analysis, pathological stage (pStage) (p = 0.0002) and a high RDW (p = 0.0300) were found to be independently associated with poor survival. Patients with a high RDW had a significantly poorer prognosis in terms of CSS than those with a low RDW (p = 0.004).

Among non-elderly patients, multivariate analysis demonstrated that pStage (p = 0.0120), and a high RDW (p = 0.0092) were independent risk factors for a worse prognosis. In addition, non-elderly patients with a high RDW had a significantly poorer prognosis in terms of CSS than those with a low RDW (p = 0.0003).

On the other hand, univariate analysis demonstrated that pStage (p = 0.0008) was the only significant risk factor for a poor prognosis in elderly patients.

Conclusions

We confirmed that a high RDW was significantly associated with the CSS of esophageal cancer patients after curative esophagectomy. Furthermore, in non-elderly patients, a high RDW was a significant and independent predictor of poor survival.

Paraneoplastic thrombocytosis in gastrointestinal cancer

It has been demonstrated recently in several solid tumors that thrombocytosis at diagnosis may correlate with tumor invasion, metastatic progression and worse outcome. Several details of the pathomechanism of the relationship of thrombocytosis and cancer have been elucidated; however, the complete process is not clearly understood. Several hypotheses have been proposed. Recently, it was suggested that in ovarian cancer elevated IL-6 production by the tumor may induce increased megakaryopoiesis via hepatic thrombopoietin production leading to thrombocytosis. The importance of the prognostic power of elevated platelet count is still debated in gastrointestinal cancer. The aims of this review were to evaluate the prognostic significance of thrombocytosis in gastrointestinal tumors, to see whether clinical practice confirmed the hypotheses and to reveal the causes of the inconsistent findings.

Resistance to multikinase inhibitor actions mediated by insulin like growth factor-1

Background

Blood platelet numbers are correlated with growth and aggressiveness of several tumor types, including hepatocellular carcinoma (HCC). We previously found that platelet lysates (hPLs) both stimulated HCC cell growth and migration, and antagonized the growth-inhibitory and apoptotic effects of Regorafenib, multikinase growth inhibitor, on HCC cell lines. We evaluated the effects of human insulin-like growth factor-1 (IGF1), a mitogen contained in platelets, on the Regorafenib-mediated growth inhibition.

Methods

An Elisa kit was used to evaluate hPL IGF1 concentrations. The effects of IGF1 on cell proliferation were assessed with MTT assay and analysis of cell cycle progression. Apoptosis assays, scratch assay and Transwell assay were performed to measure apoptosis, cell migration and invasion respectively. Western blots were performed by standard protocols.

Results

IGF1 antagonized growth inhibition exerted by Regorafenib on HCC cell lines. Moreover the mitogen blocked Regorafenib-induced apoptosis and decreased the rate of cell migration and invasion. The IGF1 effects were in turn antagonized by actions of a potent IGF1 receptor inhibitor, GSK1838705A, showing that the IGF1 receptor was involved in the mechanisms of IGF1-mediated blocking of Regorafenib action. GSK1838705A also partially blocked the effects of hPLs in antagonizing Regorafenib-mediated growth inhibition, showing that IGF1 was an important component of hPL actions.

Conclusions

These results show that IGF1 antagonized Regorafenib-mediated growth, migration and invasion inhibition, as well as the drug-mediated induction of apoptosis in HCC cells and reinforce the idea that microenvironmental factors can influence cancer drug actions.

The prognostic role of neutrophils to lymphocytes ratio and platelet count in gastric cancer: A meta-analysis

BACKGROUND

Systemic inflammatory response was reported to be associate with a poor survival in gastric cancer. However, these results remain inconsistent. The purpose of this meta-analysis was to evaluate the prognostic role of neutrophils to lymphocytes ratio (NLR) and platelet count in gastric cancer.

METHODS

Relevant studies were identified by searching PubMed, Embase and Cochrane Library. Data was pooled using a fixed-effects models or random-effects models.

RESULTS

A total of 29 studies were included for meta-analysis (19 for NLR, 10 for platelet count). Elevated NLR and platelet count were associated with an increased lymph node metastasis and serosal invasion (T3+T4) risk with individual ORs being 1.70 (95% CI: 1.05-2.75) and 2.93 (95% CI: 2.27-3.78), 1.62 (95% CI: 1.08-2.42) and 2.09 (95% CI: 1.57-2.77), respectively. The incidence of stage (III + IV) in elevated NLR group was higher than in normal NLR group (OR = 1.87, 95% CI: 1.48-2.35). The disease-free survival in patients with elevated NLR was markedly shorter (HR = 1.61; 95% CI: 1.28-1.94). For the overall survival, both indicators were strong predictors with individual HRs being 1.65 (95% CI: 1.47-1.83), 1.61 (95% CI: 1.35-1.86), respectively.

CONCLUSIONS

This meta-analysis suggests that elevated NLR and platelet count predict poor survival in patients with gastric cancer, and may provides some useful evidence for the clinical application of the two prognostic indicators in gastric cancer.