Is thrombocytosis a valid indicator of advanced stage and high mortality of gynecological cancer?

• A strong association exists between prediagnostic (up to 3 years) platelet levels and stage of gynecological cancer at diagnosis.
• We did not observe any differences in prediagnostic thrombocytosis according to histological subgroups in neither endometrial nor ovarian cancers.
• Prediagnostic thrombocytosis is significantly associated with inferior survival and not only due to level of stage at diagnosis per se.

ObjectiveThrombocytosis has been associated with higher stage and mortality of cancer, however, the evidence is conflicting. We examined the stage distribution and prognosis of gynecologic cancer according to levels of prediagnostic platelet count.MethodsIn a primary care resource with blood cell counts from more than 500,000 individuals, we identified 581 women with a primary diagnosis of gynecological cancer. We divided the pre-diagnostic mean platelet count derived from the 3-year period prior to cancer diagnosis into three categories of thrombocytosis (no, 150–400 × 109/L; mild, > 400–550 × 109/L; severe, > 550 × 109/L). Logistic regression models were used to calculate odds ratios (ORs) for the association of prediagnostic platelet counts with stage at diagnosis. Subsequently, we estimated hazard ratios (HRs) for all-cause or gynecological cancer-specific mortality by level of thrombocytosis using Cox proportional hazard regression models.ResultsPatients with non-localized disease had higher levels of prediagnostic platelet count [mild thrombocytosis: OR, 2.36 (95% CI, 1.33–4.19); severe thrombocytosis: 4.54 (95% CI, 1.55–13.3); compared with no prediagnostic thrombocytosis]. The median overall survival was 1.04 years among patients with severe prediagnostic thrombocytosis and 3.25 years among those with mild thrombocytosis, P < 0.0001. When adjusting for stage at diagnosis, elevated all-cause mortality remained with both mild (HR = 1.51; 95% CI, 1.08–2.12) and severe (HR = 3.15; 95% CI 1.95-5.08) prediagnostic thrombocytosis. Similar associations were found for cancer-specific mortality.ConclusionsPrediagnostic thrombocytosis was associated with advanced stage of gynecological cancer at diagnosis and increased all-cause and cancer-specific mortality. The platelet count may have an important role in diagnosis and post-diagnostic control of gynecological cancer.