血小板增多与上皮性卵巢癌临床病理及生存预后的相关性研究

目的:研究术前血小板(PLT)与卵巢癌临床病理和预后的相关性。方法:回顾分析2009年1月至2013年3月于同济大学附属第一妇婴保健院行手术治疗的171例卵巢癌、218例卵巢良性上皮性肿瘤和59例交界性肿瘤患者的临床资料,分析PLT计数与患者年龄、病理类型、临床分期、细胞分级、CA125水平等临床病理因素之间的关系,同时分析比较卵巢癌伴或不伴PLT增多以及化疗后PLT变化对患者生存的影响。结果:卵巢癌患者术前PLT计数平均值为248.0×109/L,显著高于良性及交界性肿瘤(188.3×109/L和206.9×109/L,P0.0001)。171例卵巢癌患者中20例(11.7%)合并血小板增多(PLT≥350×109/L),卵巢癌合并PLT增多的患者中晚期比例高(P=0.030),更易发生大网膜(P=0.006)、腹膜(P=0.016)、膈下腹膜(P=0.018)转移,达到满意肿瘤减灭术比例较低(P=0.010)。卵巢癌患者的术前PLT与CA125值呈正相关(P=0.049)。患者术前PLT计数分别为≥232.2×109/L、208.5×109/L和327.5×109/L时,可依次最大程度预测卵巢癌减灭手术不满意、疾病处于晚期及总体预后不良。卵巢癌合并PLT增多及术前PLT与3周期化疗后PLT比值大于2的患者的生存时间明显缩短(P0.0001,P=0.006)。结论:卵巢癌患者术前PLT计数显著高于良性及交界性卵巢肿瘤。合并PLT增多的患者晚期肿瘤及多脏器转移比例显著增高,满意肿瘤减灭术比例低。PLT增多及化疗后PLT较术前显著下降是卵巢癌的不良预后指标。

The association of thrombocytosis and clinicalpathologic factors and overall survival among epithelial ovarian cancer

Objective： To evaluate the impact of pretreatment thrombocytosis and platelet count reduction post-adjuvant chemotherapy on survival in patients with ovarian cancer.Methods： From Jan. 2009 to Mar. 2013,171 patients with ovarian cancer,218 patients with benign tumor and 59 patients with borderline tumor as controls underwent surgery in Shanghai First maternity and infant hospital. The prognostic significance of thrombocytosis and platelet count reduction post-adjuvant chemotherapy,together with various clinicopatholgical factors,were evaluated by multivariate analysis. Results： The mean platelet count in ovarian cancer group was significantly higher than that in benign tumor group and in borderline tumor group（248.0×10^9/L vs 188. 3 ×10^9/L、206. 9 ×10^9/L,P〈0. 0001）. Twenty of 171（ 11. 7%） patients had thrombocytosis（ PLT≥350×10^9/L） at primary diagnosis. Patients with preoperative thrombocytosis had more advanced stage（ P = 0. 030）,more frequent omentum majus、peritoneum and diaphragm metastases（ P = 0. 006,P = 0. 016 and P = 0. 018）,and demonstrated a greater likelihood of suboptimal resection（ residue tumor size ≥1cm,P = 0. 010）. Preoperative platelet count and CA125 level were positively correlated in ovarian cancer patients（ P= 0. 049）. Preoperative thrombocytosis and a high platelet reduction ratio after chemotherapy were risk factor for reduce survival（ P〈0. 0001 and P = 0. 006）. Conclusion： Platelet count in ovarian cancer patients was higher than in benign or borderline tumor patients. Patients with thrombocytosis had more advanced stage disease and showed a lower ratio of optimal cytoreduction. Preoperative thrombocytosis and a high platelet reduction ratio after chemotherapy appear to be poor prognostic factors of survival in patients with ovarian cancer.