Skip to main content

Advertisement

SpringerLink
Log in

Prognostic value of thrombocytosis in patients undergoing surgery for colorectal cancer with synchronous liver metastases

  • Research Article
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to evaluate the prognostic role of thrombocytosis in patients with synchronous colorectal liver metastases (CRLM).

Methods

Retrospective analysis of patients who underwent surgery for colorectal cancer with synchronous CRLM at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust between 2005 and 2016.

Results

One hundred and ninety-six patients met the inclusion criteria. High platelet count (H-PC) was found in 32%, and it was associated with a higher rate of palliative surgery (p < 0.001), extra-hepatic metastases (p < 0.001), bilobar liver disease (p = 0.007), presence of more than three metastases (p = 0.005), biggest metastasis larger than 5 cm (p < 0.001), and CEA level higher than 200 ng/mL (p = 0.035). H-PC was significantly associated with poorer 5-year overall survival (14.3% vs. 34.3%; p = 0.001). At the multivariate analysis on R0-1 cases, platelet count resulted the only independent predictor of survival (HR 2.07, p = 0.036).

Conclusion

H-PC correlates with the main negative clinical–pathological factors in patients with synchronous CRLM, as well as with overall survival. Moreover, it was the only independent prognostic factor in those who underwent curative surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

CRC:

Colorectal cancer

CRLM:

Colorectal liver metastasis

CEA:

Carcinoembryonic antigen

PC:

Platelet count

L-PC:

Low platelet count

H-PC:

High platelet count

PPV:

Positive predictive value

NPV:

Negative predictive value

References

  1. Manfredi S, Lepage C, Hatem C, Coatmeur O, Faivre J, Bouvier AM. Epidemiology and management of liver metastases from colorectal cancer. Ann Surg. 2006;244:254–9.

    Article  Google Scholar 

  2. Leporrier J, Maurel J, Chiche L, Bara S, Segol P, Launoy G. A population-based study of the incidence, management and prognosis of hepatic metastases from colorectal cancer. Br J Surg. 2006;93:465–74. https://doi.org/10.1002/bjs.5278.

    Article  CAS  PubMed  Google Scholar 

  3. Sandström P, Røsok BI, Sparrelid E, Larsen PN, Larsson AL, Lindell G, et al. ALPPS improves resectability compared with conventional two-stage hepatectomy in patients with advanced colorectal liver metastasis. Ann Surg. 2017;267:1.

    Google Scholar 

  4. Torzilli G, Adam R, Viganò L, Imai K, Goransky J, Fontana A, et al. Surgery of colorectal liver metastases: pushing the limits. Liver Cancer. 2016;6:80–9.

    Article  Google Scholar 

  5. Adam R, Yi B, Innominato PF, Barroso E, Laurent C, Giuliante F, et al. Resection of colorectal liver metastases after second-line chemotherapy: Is it worthwhile? A LiverMetSurvey analysis of 6415 patients. Eur J Cancer. 2017;78:7–15.

    Article  Google Scholar 

  6. Akgül Ö, Çetinkaya E, Ersöz Ş, Tez M. Role of surgery in colorectal cancer liver metastases. World J Gastroenterol 2014;20:6113–22.

    Article  Google Scholar 

  7. Mattar RE, Al-Alem F, Simoneau E, Hassanain M. Preoperative selection of patients with colorectal cancer liver metastasis for hepatic resection. World J Gastroenterol. 2016;22:567–81.

    Article  CAS  Google Scholar 

  8. Viganò L, Capussotti L, Lapointe R, Barroso E, Hubert C, Giuliante F, et al. Early recurrence after liver resection for colorectal metastases: risk factors, prognosis, and treatment. A LiverMetSurvey-based study of 6025 patients. Ann Surg Oncol. 2014;21:1276–86. https://doi.org/10.1245/s10434-013-3421-8.

    Article  PubMed  Google Scholar 

  9. Rees M, Tekkis PP, Welsh FKS, O’Rourke T, John TG. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg. 2008;247:125–35.

    Article  Google Scholar 

  10. Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema K, Bachellier P, et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Cancer. 1996;77:1254–62.

    Article  CAS  Google Scholar 

  11. Minagawa M, Yamamoto J, Kosuge T, Matsuyama Y, Miyagawa S, Makuuchi M. Simplified staging system for predicting the prognosis of patients with resectable liver metastasis. Arch Surg. 2007;142:269. https://doi.org/10.1001/archsurg.142.3.269.

    Article  PubMed  Google Scholar 

  12. Pedrazzani C, Mantovani G, Fernandes E, Bagante F, Luca Salvagno G, Surci N, et al. Assessment of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and platelet count as predictors of long-term outcome after R0 resection for colorectal cancer. Sci Rep. 2017;7:1–10.

    Article  CAS  Google Scholar 

  13. Kozak MM, von Eyben R, Pai JS, Anderson EM, Welton ML, Shelton AA, et al. The prognostic significance of pretreatment hematologic parameters in patients undergoing resection for colorectal cancer. Am J Clin Oncol. 2017;40:405–12.

    Article  Google Scholar 

  14. Dell’Aquila E, Cremolini C, Zeppola T, Lonardi S, Bergamo F, Masi G, et al. Prognostic and predictive role of neutrophil/lymphocytes ratio in metastatic colorectal cancer: a retrospective analysis of the TRIBE study by GONO. Ann Oncol. 2018;29:924–30.

    Article  Google Scholar 

  15. Edge SB, Byrd DR, Compton CC, Fritz AG, Green FL, Trotti A. AJCC cancer staging manual, 7th ed. 2010.

  16. Pedrazzani C, Lauka L, Sforza S, Ruzzenente A, Nifosì F, Delaini GG, et al. Management of nodal disease from colon cancer in the laparoscopic era. Int J Colorectal Dis. 2015;30:303–14.

    Article  Google Scholar 

  17. Pang YY, Strasberg SM. The Brisbane 2000 terminology of liver anatomy and resections. HPB. 2000;2:333–9.

    Article  Google Scholar 

  18. Agha RA, Borrelli MR, Vella-Baldacchino M, Thavayogan R, Orgill DP, Pagano D, et al. The STROCSS statement: strengthening the reporting of cohort studies in surgery. Int J Surg. 2017;46:198–202.

    Article  Google Scholar 

  19. Bensalah K, Leray E, Fergelot P, Rioux-Leclercq N, Tostain J, Guillé F, et al. Prognostic value of thrombocytosis in renal cell carcinoma. J Urol. 2006;175:859–63.

    Article  Google Scholar 

  20. Ikeda M, Furukawa H, Imamura H, Shimizu J, Ishida H, Masutani S, et al. Poor prognosis associated with thrombocytosis in patients with gastric cancer. Ann Surg Oncol. 2002;9:287–91.

    Article  Google Scholar 

  21. Shimada H, Oohira G, Okazumi S, Matsubara H, Nabeya Y, Hayashi H, et al. Thrombocytosis associated with poor prognosis in patients with esophageal carcinoma. J Am Coll Surg. 2004;198:737–41.

    Article  Google Scholar 

  22. Guo T, Krzystanek M, Szallasi Z, Szallasi A. Thrombocytosis portends adverse prognostic significance in patients with stage II colorectal carcinoma. F1000Research. 2014;3:180.

    Article  Google Scholar 

  23. Cravioto-Villanueva A, Luna-Perez P, Gutierrez-de la Barrera M, Martinez-Gómez H, Maffuz A, Rojas-Garcia P, et al. Thrombocytosis as a predictor of distant recurrence in patients with rectal cancer. Arch Med Res. 2012;43:305–11.

    Article  Google Scholar 

  24. Wan S, Lai Y, Myers RE, Li B, Hyslop T, London J, et al. Preoperative platelet count associates with survival and distant metastasis in surgically resected colorectal cancer patients. J Gastrointest Cancer. 2013;44:293–304.

    Article  Google Scholar 

  25. Gasic GJ, Gasic TB, Stewart CC. Antimetastatic effects associated with platelet reduction. Proc Natl Acad Sci USA. 1968;61:46–52.

    Article  CAS  Google Scholar 

  26. Pearlstein E, Ambrogio C, Karpatkin S. Effect of antiplatelet antibody on the development of pulmonary metastases following injection of CT26 colon adenocarcinoma, Lewis lung carcinoma, and B16 amelanotic melanoma tumor cells into mice. Cancer Res. 1984;44:3884–7.

    CAS  PubMed  Google Scholar 

  27. Kawai K, Watanabe T. Colorectal cancer and hypercoagulability. Surg Today. 2014;44:797–803.

    Article  CAS  Google Scholar 

  28. Poggi A, Stella M, Donati MB. The importance of blood cell-vessel wall interactions in tumour metastasis. Baillieres Clin Haematol. 1993;6:731–52.

    Article  CAS  Google Scholar 

  29. Placke T, Kopp H-G, Salih HR. The wolf in sheep’s clothing: platelet-derived “pseudo self” impairs cancer cell “missing self” recognition by NK cells. Oncoimmunology. 2012;1:557–9.

    Article  Google Scholar 

  30. Seretis C, Youssef H, Chapman M. Hypercoagulation in colorectal cancer: What can platelet indices tell us? Platelets. 2015;26:114–8.

    Article  CAS  Google Scholar 

  31. Pedrazzani C, Mantovani G, Salvagno GL, Baldiotti E, Ruzzenente A, Iacono C, et al. Elevated fibrinogen plasma level is not an independent predictor of poor prognosis in a large cohort of Western patients undergoing surgery for colorectal cancer. World J Gastroenterol. 2016;22:9994–10001.

    Article  CAS  Google Scholar 

  32. Kandemir E, Mayadagli A, Karagoz B, Bilgi O, Turken O, Yaylaci M. Prognostic significance of thrombocytosis in node-negative colon cancer. J Int Med Res. 2005;33:228–35. https://doi.org/10.1177/147323000503300211.

    Article  CAS  PubMed  Google Scholar 

  33. Toiyama Y, Inoue Y, Kawamura M, Kawamoto A, Okugawa Y, Hiro J, et al. Elevated platelet count as predictor of recurrence in rectal cancer patients undergoing preoperative chemoradiotherapy followed by surgery. Int Surg. 2015;100:199–207.

    Article  Google Scholar 

  34. Leitch EF, Chakrabarti M, Crozier JEM, McKee RF, Anderson JH, Horgan PG, et al. Comparison of the prognostic value of selected markers of the systemic inflammatory response in patients with colorectal cancer. Br J Cancer. 2007;97:1266–70.

    Article  CAS  Google Scholar 

  35. Lee YS, Suh KW, Oh SY. Preoperative thrombocytosis predicts prognosis in stage II colorectal cancer patients. Ann Surg Treat Res. 2016;90:322–7.

    Article  CAS  Google Scholar 

  36. Kulik U, Schrem H, Bektas H, Klempnauer J, Lehner F. Prognostic relevance of hematological profile before resection for colorectal liver metastases. J Surg Res. 2016;206:498–506.

    Article  Google Scholar 

  37. Nyasavajjala SM, Runau F, Datta S, Annette H, Shaw AG, Lund JN. Is there a role for pre-operative thrombocytosis in the management of colorectal cancer? Int J Surg. 2010;8:436–8.

    Article  Google Scholar 

  38. Rao X-D, Zhang H, Xu Z-S, Cheng H, Shen W, Wang X-P. Poor prognostic role of the pretreatment platelet counts in colorectal cancer. Medicine. 2018;97:e10831.

    Article  Google Scholar 

  39. Del Prete M, Giampieri R, Loupakis F, Prochilo T, Salvatore L, Faloppi L, et al. Prognostic clinical factors in pretreated colorectal cancer patients receiving regorafenib: implications for clinical management. Oncotarget. 2015;6:33982–92.

    PubMed  PubMed Central  Google Scholar 

  40. Neal CP, Cairns V, Jones MJ, Masood MM, Nana GR, Mann CD, et al. Prognostic performance of inflammation-based prognostic indices in patients with resectable colorectal liver metastases. Med Oncol. 2015;32:144. https://doi.org/10.1007/s12032-015-0590-2.

    Article  PubMed  Google Scholar 

  41. Kronborg CS, Jensen AR. Prognostic factors for overall survival in metastatic colorectal cancer using a stop-and-go FLIRI-based treatment strategy. Int J Colorectal Dis. 2015;30:1059–65. https://doi.org/10.1007/s00384-015-2264-0.

    Article  PubMed  Google Scholar 

  42. Neal CP, Mann CD, Sutton CD, Garcea G, Ong SL, Steward WP, et al. Evaluation of the prognostic value of systemic inflammation and socioeconomic deprivation in patients with resectable colorectal liver metastases. Eur J Cancer. 2009;45:56–64.

    Article  CAS  Google Scholar 

  43. Jósa V, Krzystanek M, Vass T, Lang T, Juhász V, Szilágyi K, et al. Thrombocytosis of liver metastasis from colorectal cancer as predictive factor. Pathol Oncol Res. 2015;21:991–7. https://doi.org/10.1007/s12253-015-9925-8.

    Article  CAS  PubMed  Google Scholar 

  44. Pawlik TM, Vauthey J-N. Surgical margins during hepatic surgery for colorectal liver metastases: complete resection not millimeters defines outcome. Ann Surg Oncol. 2008;15:677–9.

    Article  Google Scholar 

Download references

Author information

Author notes

  1. C. Pedrazzani and G. Turri have contributed equally to this work.

Authors and Affiliations

  1. Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy

    C. Pedrazzani, G. Turri, G. Mantovani, C. Conti, R. Ziello, S. Conci, T. Campagnaro, A. Ruzzenente & A. Guglielmi

  2. Division of General and Hepatobiliary Surgery, University Hospital “G.B. Rossi”, Piazzale Scuro 10, 37134, Verona, Italy

    C. Pedrazzani

Authors
  1. C. Pedrazzani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Turri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Mantovani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Conti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Ziello
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Conci
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T. Campagnaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Ruzzenente
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. Guglielmi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Pedrazzani.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The latest revision of the Helsinki Declaration and the Oviedo Declaration are the basis for the ethical conduct of the study. Ethical approval was obtained by the ethics committee of the University of Verona Hospital Trust with the reference number “42763 (CRINF-1034 CESC)”.

Informed consent

Achievement of informed consent from all patients was required to enter the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pedrazzani, C., Turri, G., Mantovani, G. et al. Prognostic value of thrombocytosis in patients undergoing surgery for colorectal cancer with synchronous liver metastases. Clin Transl Oncol 21, 1644–1653 (2019). https://doi.org/10.1007/s12094-019-02093-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-019-02093-z

Keywords

Search

Navigation