Annals of Surgical Oncology

, Volume 22, Issue 2, pp 513–519 | Cite as

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

Colorectal Cancer



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.


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.


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.


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.


Rectal Cancer Platelet Count Oncologic Outcome Thrombocytosis Rectal Cancer Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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.


The authors declare no conflicts of interest.

Supplementary material

10434_2014_3988_MOESM1_ESM.tif (59.8 mb)
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 (59.8 mb)
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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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  1. 1.Colorectal Cancer Center, Kyungpook National University Medical Center, School of MedicineKyungpook National UniversityDaeguKorea
  2. 2.Department of Surgical Oncology, Faculty of MedicineThe University of TokyoTokyoJapan

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