Subscribe to RSS
Download PDF
DOI: 10.1055/s-0037-1615093
Platelet Count and Survival in Patients with Colorectal Cancer – a Preliminary Study
Publication History
Received
19 September 1997
Accepted after resubmission
07 January 1998
Publication Date:
07 December 2017 (online)
Summary
In a previous report we found an inverse correlation between pre-operative platelet count (PlC) levels and the risk of post-operative pulmonary embolism in patients undergoing hip surgery. In the present study, we prospectively evaluated the prognostic significance of pre-operative PlC levels on survival in 180 consecutive patients undergoing surgery for colorectal cancer. Other major clinicopathological parameters studied were age, gender, Dukes’ stage, duration of surgery, pre-operative haemoglobin levels and transfusion requirements.
There were no significant differences in mean pre-operative PlC levels according to tumor stage. Thirty-three patients (18%) died during follow-up (3-23 months, median: 13 months). Univariate analysis (Kaplan-Meier estimates) showed that advanced tumor stage (p <0.001), duration of surgery (p <0.05) and a high pre-operative PlC level (p <0.001) were significantly associated to a poor survival. The multivariate Cox analysis revealed that tumor stage (RR:5.734; 95%C.I.: 2.644-12.44), a high pre-operative PlC level (RR: 2.467; 95%C.I.: 1.117-5.452), and to a lesser extent the patients’ age remained independent prognostic variables for mortality. The findings of this preliminary study may be of interest from the point of view of pathogenesis, but also clinically, since they might be used in the decision as to which patients or groups of patients should receive more aggressive therapeutic intervention.
-
References
- 1 Monreal M, Lafoz E, Roca J, Granero X, Soler JM, Salazar X. et al. Platelet count, antiplatelet therapy and pulmonary embolism. A prospective study in patients with hip surgery. Thromb Haemost 1995; 73: 380-5.
- 2 Monreal M, Lafoz E, Llamazares J, Roncalés J, Roca J, Granero X. Preoperative platelet count and postoperative blood loss in patients undergoing hip surgery. An inverse correlation. Haemostasis 1996; 26: 164-9.
- 3 Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457-81.
- 4 Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV. et al. Design and analysis of randomized clinical trials requiring prolonged observation of each patient, II: analysis and examples. Br J Cancer 1977; 35: 1-39.
- 5 Statistics and epidemiology research corporation and Cytel software corporation: EGRET. Reference manual, 1990.
- 6 Cox DR. Regression models and life-tables. J R Stat Soc B 1972; 34: 187-220.
- 7 Hernandez E, Lavine M, Dunton CJ, Gracely E, Parker J. Poor prognosis associated with thrombocytosis in patients with cervical cancer. Cancer 1992; 69: 2975-7.
- 8 Rodriguez GC, Clarke-Pearson DL, Soper JT, Berchuk A, Synan I, Dodge RK. The negative prognostic implications of thrombocytosis in women with stage IB cervical cancer. Obstet Gynecol 1994; 83: 445-8.
- 9 Lopes A, Daras V, Cross PA, Robertson G, Beynon G, Monaghan JM. Thrombocytosis as a prognostic factor in women with cervical cancer. Cancer 1994; 74: 90-2.
- 10 Hernandez E, Heller PB, Whitney C, Diana K, Delgado G. Thrombocytosis in surgically treated stage IB squamous cell cervical carcinoma (A gyneco-logic oncology group study). Gynecol Oncol 1994; 55: 328-32.
- 11 Zeimet AG, Marth C, Müller-Holzner E, Daxenbichler G, Dapunt O. Significance of thrombocytosis in patients with epithelial ovarian cancer. Am J Obstet Gynecol 1994; 170: 549-54.
- 12 Sagman U, Maki E, Evans WK, Warr D, Shepherd FA, Sculier JP. et al. Small-cell carcinoma of the lung: derivation of a prognostic staging system. J Clin Oncol 1991; 9: 1639-49.
- 13 Quoix E, Hedelin G, Popin E, Charloux A, Dietemann A, Seibert R. et al. Can we predict very short term survival in small cell lung cancer?. Lung Cancer 1993; 10: 229-38.
- 14 Pedersen LM, Milman N. Prognostic significance of thrombocytosis in patients with primary lung cancer. Eur Respir J 1996; 9: 1826-30.
- 15 Davis RB, Theologides A, Kennedy BJ. Comparative studies of blood coagulation and platelet aggregation in patients with cancer and nonmalignant diseases. Ann Intern Med 1969; 71: 67-80.
- 16 Brugarolas A, Mink IB, Elias EG, Mittelman A. Correlation of hyperfibrinogenemia with major thromboembolism in patients with cancer. Surg Gyn Obstet 1973; 136: 75-7.
- 17 Editorial.. Haemostatic abnormalities and malignant disease. Lancet 1986; 1: 303-4.
- 18 Edwards RL, Rickles FR, Moritz TE, Henderson WG, Zacharski LR, Forman WB. et al. Abnormalities of blood coagulation tests in patients with cancer. Am J Clin Pathol 1987; 88: 596-602.
- 19 Costantini V, Zacharski LR, Moritz TE, Edwards RL. The platelet count in carcinoma of the lung and colon. Thromb Haemost 1990; 64: 501-5.
- 20 Falanga A, Barbui T, Rickles FR, Levine MN. Guidelines for clotting studies in cancer patients. Thromb Haemost 1993; 70: 540-2.
- 21 Davis WM, Ross AOM. Thrombocytosis and thrombocytemia: the clinical and laboratory significance of an elevated platelet count. Am J Clin Pathol 1973; 59: 243-7.
- 22 Schilling RF. Platelet millionaires. Lancet 1980; 2: 372-3.
- 23 Estrov Z, Talpaz M, Mavligit G, Pazdur R, Harris D, Greenberg SM. Elevated plasma thrombopoietic activity in patients with metastatic cancer-related thrombocytosis. Amer J Med 1995; 98: 551-8.
- 24 Iversen LH, Okholm M, Thorlacius Ussing O. Pre- and postoperative state of coagu-lation and fibrinolysis in plasma of patients with benign and malignant colorectal disease- A preliminary Study. Thromb Haemost 1996; 76: 523-8.
- 25 Edwards CM, Warren J, Armstrong L, Donnelly PK. D-dimer: a useful marker of disease stage in surgery for colorectal cancer. Br J Surg 1993; 80: 1404-5.
- 26 Iversen LH, Thorlacius-Ussing O, Okholm M. Soluble fibrin in plasma before and after surgery for benign and malignant colorectal disease. Thromb Res 1995; 79: 471-581.
- 27 Kakkar AK, DeRuvo N, Chinswangwatanakul V, Tebbutt S, Williamson RCN. Extrinsic-pathway activation in cancer with high factor VIIa and tissue factor. Lancet 1995; 346: 1004-5.
- 28 Tuszynski GP, Gasic TB, Rothman VL, Knudsen KA, Gasic GJ. Thrombospondin, a potentiator of tumor cell metastasis. Cancer Res 1987; 47: 4130-3.
- 29 Boukerche H, Berthier-Vergnes O, Bailly M, Doré JF, Leung LLK, McGregor JL. A monoclonal antibody (LYP18) directed against the blood platelet glycoprotein IIb/IIIa complex inhibits human melanoma growth in vivo. Blood 1989; 74: 909-12.
- 30 Nierodzyk ML, Bain RM, Liu LX, Shivji M, Takeshita K, Karpatkin S. Presence of the seven transmembrane thrombin receptor on human tumour cells: effect of activation on tumour adhesion to platelets and tumour tyrosine phosphorilation. Brit J Haematol 1996; 92: 452-7.
- 31 Monreal M, Lafoz E, Casals A, Ruiz J, Arias A. Platelet count and venous thrombo-embolism. A useful test for suspected pulmonary embolism. Chest 1991; 100: 1493-6.
- 32 Monreal M, Lafoz E, Ruiz J, Gimenez G. Platelet count in acute pulmonary embolism: its relationship to recurrences. Haemostasis 1993; 23: 263-8.
- 33 Monreal M, Urrutia A, Martí S, Cuxart A, Roncalés J. Platelet count and the risk of bleeding in hospitalized patients with venous thromboembolism starting anticoagulant therapy. Haemostasis 1997; 27: 91-8.