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Clinical Significance of Thrombocytosis Before Preoperative Chemoradiotherapy in Rectal Cancer: Predicting Pathologic Tumor Response and Oncologic Outcome

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Thrombocytosis is considered an adverse prognostic factor in various malignancies. However, the clinical significance of thrombocytosis in rectal cancer patients is unknown. We investigated the predictive value of thrombocytosis for pathologic tumor response to preoperative chemoradiotherapy (CRT) and oncologic outcomes in patients with rectal cancer.

Methods

A total of 314 patients who underwent preoperative CRT and subsequent rectal resection for rectal cancer were retrospectively evaluated at two tertiary institutions. Univariate and multivariate analyses of the clinical parameters were performed to identify markers predictive of a pathologic complete response (pCR). The Kaplan–Meier method was used to estimate 3-year disease-free and overall survival rates.

Results

Sixty-nine patients (22 %) had thrombocytosis before CRT, which significantly correlated with a large tumor size and advanced tumor depth. Thirty-nine patients (12.4 %) achieved a pCR. In the multivariate analyses, a platelet count of <370,000/μl (odds ratio 5.483; 95 % confidence interval, 1.271–23.653; P = 0.023) and a carcinoembryonic antigen (CEA) level of <5 ng/dl (odds ratio, 3.084; 95 % confidence interval, 1.291–7.368; P = 0.011) were identified as independent predictive factors for a pCR. Patients with pretreatment thrombocytosis had lower 3-year disease-free (P = 0.037) and overall survival (P = 0.001) rates than patients with normal pretreatment platelet counts.

Conclusions

Thrombocytosis is a negative predictive factor for a pCR and has an adverse impact on survival in rectal cancer. The predictive value of this easily available clinical factor should not be underestimated, and better therapeutic strategies for these tumors are required.

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Acknowledgment

Hye Jin Kim designed the study and wrote the manuscript; Gyu-Seog Choi and Toshiaki Watanabe, both were responsible for correspondence and the study proposal; Jun Seok Park, SooYeun Park, and Kazushige Kawai provided data collection and analysis, and approved the final manuscript.

Disclosure

The authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea

    Hye Jin Kim MD, Gyu-Seog Choi MD, Jun Seok Park MD & SooYeun Park MD

  2. Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan

    Kazushige Kawai MD & Toshiaki Watanabe MD

Authors
  1. Hye Jin Kim MD
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  2. Gyu-Seog Choi MD
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  3. Jun Seok Park MD
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  4. SooYeun Park MD
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  5. Kazushige Kawai MD
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  6. Toshiaki Watanabe MD
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Corresponding authors

Correspondence to Gyu-Seog Choi MD or Toshiaki Watanabe MD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10434_2014_3988_MOESM1_ESM.tif

Supplement 1. Kaplan–Meier cumulative survival curves relative to thrombocytosis groupings categorized with respect to pre- and post-CRT platelet counts; those with pre-CRT and post-CRT platelet counts <370,000/µL (Group A); those with pre-CRT platelet counts ≥370,000/µL and post-CRT platelet counts <370,000/µL (Group B); and those with post-CRT platelet counts ≥370,000/µl regardless of the pre-CRT platelet count (Group C). (A) Disease-free survival (TIFF 61206 kb)

10434_2014_3988_MOESM2_ESM.tif

Supplement 2. Kaplan–Meier cumulative survival curves relative to thrombocytosis groupings categorized with respect to pre- and post-CRT platelet counts; those with pre-CRT and post-CRT platelet counts <370,000/µL (Group A); those with pre-CRT platelet counts ≥370,000/µL and post-CRT platelet counts <370,000/µL (Group B); and those with post-CRT platelet counts ≥370,000/µl regardless of the pre-CRT platelet count (Group C). (B) Overall Survival. (TIFF 61206 kb)

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Kim, H.J., Choi, GS., Park, J.S. et al. Clinical Significance of Thrombocytosis Before Preoperative Chemoradiotherapy in Rectal Cancer: Predicting Pathologic Tumor Response and Oncologic Outcome. Ann Surg Oncol 22, 513–519 (2015). https://doi.org/10.1245/s10434-014-3988-8

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  • DOI: https://doi.org/10.1245/s10434-014-3988-8

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