Thrombocytosis has been implicated as a potential prognostic biomarker in various malignancies, but its role in endometrial cancer (EC) remains unclear. This retrospective cohort study evaluated the prognostic value of elevated preoperative platelet count (PLT) in patients with EC. A total of 548 patients treated at Changhua Christian Hospital between 2010 and 2021 were included. Patients were classified into high (>400 × 109/L) and normal PLT groups, and propensity score matching was applied in a 1:3 ratio to balance baseline characteristics. Recurrence, disease-free survival (DFS), and overall survival (OS) were assessed using Kaplan–Meier analysis and Cox proportional hazards modeling. After matching, 224 patients were analyzed. The high PLT group demonstrated significantly higher recurrence (37.5% vs 26.8%), shorter DFS (48.2% vs 67.3%), and reduced OS (71.4% vs 83.3%). Adjusted hazard ratios for high PLT were 1.76 for recurrence, 1.98 for DFS, and 2.11 for OS. These findings suggest that thrombocytosis is an independent prognostic factor in EC and may serve as a useful tool for risk stratification and treatment planning.
Taiwan Cancer Registry. Incidence and mortality rates for the top 10 cancers among females in Taiwan, https://twcr.tw/?page_id=1855&lang=en (2021, accessed 28 March 2024).
2.
KoppikarSOakninABabuKG, et al. Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with endometrial cancer. ESMO Open2023; 8(1): 100774.
3.
SykarasAGChristofidisKPolitiE, et al. Exosomes on endometrial cancer: a biomarkers treasure trove?Cancers (Basel)2022; 14(7): 1733.
4.
YokoiEMabuchiSKomuraN, et al. Incorporation of pretreatment leukocytosis and thrombocytosis into the FIGO staging system for prognosis in surgically treated endometrial cancer. Int J Gynaecol Obstet2020; 151(2): 272–278.
5.
TalOEitanRGemerO, et al. Prognostic significance of pretreatment thrombocytosis in endometrial cancer: an Israeli Gynecologic Oncology Group study. Int J Gynecol Cancer2021; 31(11): 1437–1442.
6.
NjolstadTSEngerudHWernerHM, et al. Preoperative anemia, leukocytosis and thrombocytosis identify aggressive endometrial carcinomas. Gynecol Oncol2013; 131(2): 410–415.
7.
BalescuIBacalbasaNBrezeanI, et al. The significance of preoperative thrombocytosis in ovarian cancer patients. Roman Med J2022; 69(4): 144–146.
8.
PedersenLMMilmanN.Prognostic significance of thrombocytosis in patients with primary lung cancer. Eur Respir J1996; 9(9): 1826–1830.
9.
LongYWangTGaoQ, et al. Prognostic significance of pretreatment elevated platelet count in patients with colorectal cancer: a meta-analysis. Oncotarget2016; 7(49): 81849–81861.
10.
HuCChenRChenW, et al. Thrombocytosis is a significant indictor of hypercoagulability, prognosis and recurrence in gastric cancer. Exp Ther Med2014; 8(1): 125–132.
11.
ZhouLZhangZTianY, et al. The critical role of platelet in cancer progression and metastasis. Eur J Med Res2023; 28(1): 385.
12.
ScholzHSPetruEGücerF, et al. Preoperative thrombocytosis is an independent prognostic factor in stage III and IV endometrial cancer. Anticancer Res2000; 20(5c): 3983–3985.
13.
BussiesPEtaAPintoA, et al. Thrombocytosis as a biomarker in type II, non-endometrioid endometrial cancer. Cancers (Basel)2020; 12(9): 2379.
14.
EkiciHMalatyaliogluEKokcuA, et al. Do leukocyte and platelet counts have benefit for\preoperative evaluation of endometrial cancer?Asian Pac J Cancer Prev2015; 16(13): 5305–5310.
15.
YeQWuZXiaT, et al. Pre-treatment thrombocytosis predicts prognosis of endometrial cancer: a meta-analysis of 11 studies. Exp Ther Med2020; 19(1): 359–366.
16.
GücerFMoserFTamussinoK, et al. Thrombocytosis as a prognostic factor in endometrial carcinoma. Gynecol Oncol1998; 70(2): 210–214.
17.
AustinPC.A comparison of 12 algorithms for matching on the propensity score. Stat Med2014; 33(6): 1057–1069.
18.
AustinPC.An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res2011; 46(3): 399–424.
19.
EvstatievRBukatyAJimenezK, et al. Iron deficiency alters megakaryopoiesis and platelet phenotype independent of thrombopoietin. Am J Hematol2014; 89(5): 524–529.
20.
KristineJFlorentinaLAranL, et al. Iron deficiency-induced thrombocytosis increases thrombotic tendency in rats. Haematologica2021; 106(3): 782–794.
21.
TakahashiRMabuchiSKurodaH, et al. The significance of pretreatment thrombocytosis and its association with neutrophilia in patients with surgically treated endometrial cancer. Int J Gynecol Cancer2017; 27(7): 1399–1407.
22.
NieDYangELiZ.Pretreatment thrombocytosis predict poor prognosis in patients with endometrial carcinoma: a systematic review and meta-analysis. BMC Cancer2019; 19(1): 73.
23.
NakamuraKNakayamaKIshikawaM, et al. High pretreatment plasma D-dimer levels are related to shorter overall survival in endometrial carcinoma. Eur J Obstet Gynecol Reprod Biol2016; 201: 89–93.
24.
BalescuIBacalbasaNBrezeanI, et al. The impact of thrombocytosis on the long term outcomes in relapsed ovarian cancer. Roman Med J2023; 70: 5–7.
25.
WangJMWangYHuangYQ, et al. Prognostic values of platelet-associated indicators in resectable cervical cancer. Dose Response2019; 17(3): 1559325819874199.
26.
BaiYYDuLJingL, et al. Clinicopathological and prognostic significance of pretreatment thrombocytosis in patients with endometrial cancer: a meta-analysis. Cancer Manag Res2019; 11: 4283–4295.
27.
SivaprasadSSheelaSR.Association of thrombocytosis and its prognostic significance in cervical cancer. J Clin Diagn Res2023; 17(2): QC10–QC13.
28.
CrastaJAPremlathaTSKrishnanSM, et al. Significance of preoperative thrombocytosis in epithelial ovarian cancer. Indian J Pathol Microbiol2010; 53(1): 54–56.
29.
ZhangXLvZYuH, et al. The clinicopathological and prognostic role of thrombocytosis in patients with cancer: a meta-analysis. Oncol Lett2017; 13(6): 5002–5008.
30.
ShuCWangXLiC, et al. Revisiting the association between pretreatment thrombocytosis and cancer survival outcomes: an umbrella review of meta-analyses. BMC Cancer2024; 24(1): 1246.
31.
HaemmerleMStoneRLMenterDG, et al. The platelet lifeline to cancer: challenges and opportunities. Cancer Cell2018; 33(6): 965–983.
32.
LiaoKZhangXLiuJ, et al. The role of platelets in the regulation of tumor growth and metastasis: the mechanisms and targeted therapy. MedComm (2020)2023; 4(5): e350.
33.
PlantureuxLMègeDCrescenceL, et al. Impacts of cancer on platelet production, activation and education and mechanisms of cancer-associated thrombosis. Cancers (Basel)2018; 10(11): 441.
34.
LabelleMBegumSHynesRO.Direct signaling between platelets and cancer cells induces an epithelial-mesenchymal-like transition and promotes metastasis. Cancer Cell2011; 20(5): 576–590.
35.
WojtukiewiczMZSierkoEHempelD, et al. Platelets and cancer angiogenesis nexus. Cancer Metastasis Rev2017; 36(2): 249–262.
36.
KitagawaHYamamotoNYamamotoK, et al. Involvement of platelet membrane glycoprotein Ib and glycoprotein IIb/IIIa complex in thrombin-dependent and -independent platelet aggregations induced by tumor cells. Cancer Res1989; 49(3): 537–541.
37.
Shawn LyBargerKMillerHAFrieboesHB. CA125 as a predictor of endometrial cancer lymphovascular space invasion and lymph node metastasis for risk stratification in the preoperative setting. Sci Rep2022; 12(1): 19783.
38.
LombaersMSCornelKMCVisserNCM, et al. Preoperative CA125 significantly improves risk stratification in high-grade endometrial cancer. Cancers (Basel)2023; 15(9): 2605.
39.
SunSWeiLZouL, et al. Preoperative serum CA125 level and age at diagnosis: an effective prognosis prediction tool for patients with early-stage endometrial cancer. Asia Pac J Clin Oncol2023; 19(5): e258–e266.
40.
BorgfeldtCHolmbergEMarcickiewiczJ, et al. Survival in endometrial cancer in relation to minimally invasive surgery or open surgery - a Swedish Gynecologic Cancer Group (SweGCG) study. BMC Cancer2021; 21(1): 658.
41.
BerekJSMatias-GuiuXCreutzbergC, et al. FIGO staging of endometrial cancer: 2023. Int J Gynaecol Obstet2023; 162(2): 383–394.
42.
OnstadMASchmandtRELuKH.Addressing the role of obesity in endometrial cancer risk, prevention, and treatment. J Clin Oncol2016; 34(35): 4225–4230.
43.
GaoYDaiXChenL, et al. Body mass index is positively associated with endometrial cancer in chinese women, especially prior to menopause. J Cancer2016; 7(9): 1169–1173.
44.
MiyataHShiraiKMurakiI, et al. Associations of body mass index, weight change, physical activity, and sedentary behavior with endometrial cancer risk among Japanese women: the Japan collaborative cohort study. J Epidemiol2021; 31(12): 621–627.
