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Prognostic significance of pretreatment thrombocytosis in endometrial cancer: an Israeli Gynecologic Oncology Group study
  1. Ori Tal1,
  2. Ram Eitan2,
  3. Ofer Gemer3,
  4. Limor Helpman4,
  5. Zvi Vaknin5,
  6. Sofia Leytes1,
  7. Ofer Lavie6,
  8. Alon Ben-Arie7,
  9. Amnon Amit8,
  10. Ahmet Namazov3,
  11. Inbar Ben Shahar9,
  12. Ilan Atlas10,
  13. Ilan Bruchim11 and
  14. Tally Levy1
  1. 1 Edith Wolfson Medical Center, Holon, Israel
  2. 2 Rabin Medical Center, Petah Tikva, Israel
  3. 3 Barzilai Medical Centre Ashkelon, Ashkelon, Southern, Israel
  4. 4 Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
  5. 5 Shamir Medical Center, Zerifin, Israel
  6. 6 Lady Davies Carmel Medical Center, Haifa, Haifa, Israel
  7. 7 Kaplan Medical Center, Rehovot, Israel
  8. 8 Rambam Medical Center, Haifa, Israel
  9. 9 Ziv Medical Center, Safed, Israel
  10. 10 Poriya Medical Center, Tiberias, Israel
  11. 11 Hillel Yaffe Medical Center, Hadera, Israel
  1. Correspondence to Dr Ori Tal, Edith Wolfson Medical Center, Holon 5822012, Israel; orital0710{at}gmail.com

Abstract

Objective Endometrial cancer prognosis is related to stage, histology, myometrial invasion, and lymphovascular space invasion. Several studies have examined the association between pretreatment thrombocytosis and patient outcomes with contrasting results regarding prognosis. Our aim was to evaluate the association of pretreatment platelet count with outcomes in endometrial cancer patients.

Methods This is an Israeli Gynecologic Oncology Group multicenter retrospective cohort study of consecutive patients with endometrial cancer, who underwent surgery between January 2002 and December 2014. Patients were grouped as low risk (endometrioid G1-G2 and villoglandular) and high risk (endometrioid G3, uterine serous papillary carcinoma, clear cell carcinoma, and carcinosarcoma). Those with stage I disease were compared with stages II–IV. Disease stages were reviewed and updated to reflect International Federation of Gynecology and Obstetrics (FIGO) 2009 staging. All patients underwent pelvic washings for cytology and total abdominal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Pelvic lymph node assessment was performed in patients with tumors of moderate–high risk histology or deep myometrial invasion. Para-aortic sampling was performed at the surgeon’s discretion. Patients were categorized by pretreatment platelet count into two groups: ≤400×109/L and >400×109/L (defined as thrombocytosis). Clinical and pathological features were compared using Student t-test, χ2 or Fisher’s exact test. Survival measures were plotted with the Kaplan-Meier method and compared using the log-rank test. A Cox proportional hazards model was used for multivariable comparison of associations.

Results Of the 1482 patients included, most had stage I disease (961; 74.8%) and most had endometrioid histology (927; 64.1%). A total of 1392 patients (94%) had pretreatment platelet counts ≤400×109/L and 90 (6%) had pretreatment thrombocytosis. Patients with thrombocytosis had a significantly higher rate of high-grade malignancy, advanced stage, lymphovascular space invasion, low uterine segment involvement, and lymph node metastases. They also had shorter 5 year disease-free survival (65% vs 80%, p=0.003), disease-specific survival (63% vs 83%, p<0.05) and overall survival (59% vs 77%, p<0.05). On multivariate analysis, an elevated pretreatment thrombocyte count remained a significant independent predictor for disease-specific survival and overall survival.

Conclusions Pretreatment thrombocytosis is an independent prognostic factor for decreased disease-specific survival and overall survival among patients with endometrial cancer, and can serve as a predictor of poor outcome.

  • uterine cancer
  • preoperative period
  • pathology

Data availability statement

Data are available upon reasonable request. In accordance with the journal’s guidelines, we will provide our data for the reproducibility of this study in other centers if such is requested.

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Data availability statement

Data are available upon reasonable request. In accordance with the journal’s guidelines, we will provide our data for the reproducibility of this study in other centers if such is requested.

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Footnotes

  • Contributors Study design and manuscript writing: TO, LT. Study selection and data analysis: GO. Data collection, quality evaluation and revision: HL, ER, VZ, LS, LO, BA-A, AA, NA, BS-I, AI, BI. All authors have read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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