Large platelet size is associated with poor outcome in patients with metastatic pancreatic cancer

Abstract

Background Platelets are a major cellular component of blood and their interaction with cancer cells is well-established to influence cancer progression and metastases. The physical size of platelets may have a critical impact on the interaction with cancer cells. In this study, we explored the potential prognostic role of platelet size measured by the determination of the mean platetlet volume (MPV) in patients with pancreatic ductal adenocarcinoma (PDAC). Methods Data from 527 patients with PDAC diagnosed and treated between 2004 and 2015 at a single center were evaluated retrospectively. Associations between MPV and baseline covariates were assessed with Wilcoxon’s rank-sum tests, χ2-tests, and Fisher’s exact tests. Median follow-up was estimated with a reverse Kaplan-Meier estimator according to Schemper and Smith. Analysis of time-to-death was performed with Kaplan-Meier estimators, log-rank tests and uni- and multivariable Cox proportional hazards models. Results The median MPV was 10.5 femto liter (fL) [9.8–11.3], ranged from 5.9 to 17.7 fL. A large platelet volume was associated with high-grade G3/4 tumors (p=0.004) and worse overall survival (OS) in patients with metastatic disease in univariable analysis (hazard ratio [HR] per fL increase in MPV=1.13 [95% CI: 1.04–1.23, p=0.005]). In multivariable analysis of metatatic PDAC patients, the adverse association between large platelets and a higher risk-of-death prevailed (adjusted HR per doubling of MPV=2.00; 95% CI: 1.10–3.62, p=0.02). Conclusions Large platelets represent a negative prognostic factor and add an independent prognostic information to well-established factors in PDAC patients. MPV should be considered for future individual risk assessment in patients with stage IV PDAC.

The prognostic value of mean platelet volume in cancer patients

“…Furthermore, the high level of MPV corresponds to the worse course of the disease in pancreatic cancer. Study of Lembeck et al [14] showed that patients with high MPV were more likely to have high-grade G3/4 tumors (p = 0.004). Moreover, they had lower average PLT, higher average bilirubin levels, and higher CRP levels.…”

“…In multivariable analysis, the adverse association between large platelets and a higher risk-of-death prevailed in metastatic stage IV patients, but not in patients with early/locally advanced disease [14]. Furthermore, in patients with pancreatic ductal adenocarcinoma (PDAC), a large platelet volume is associated with high-grade G3/4 tumors (p = 0.004) and worse OS in patients with metastatic disease in univariable analysis (p = 0.005).…”

“…Furthermore, in patients with pancreatic ductal adenocarcinoma (PDAC), a large platelet volume is associated with high-grade G3/4 tumors (p = 0.004) and worse OS in patients with metastatic disease in univariable analysis (p = 0.005). Multivariable analysis of metastatic PDAC patients showed the adverse association between large platelets and a higher risk-of-death prevailed (p = 0.02) [14]. In the other paper, Zhang et al [15] identified that prolonged prothrombin time (PT), high fibrinogen (FBG), and high MPV were independent prognostic factors for poor OS in advanced pancreatic cancer (PT > 11.3 s, p = 0.009; FBG > 2.5 g/L, p = 0.011; MPV > 12.2 fL, p = 0.005).…”

<p>Mean Platelet Volume Has Prognostic Value in Chronic Lymphocytic Leukemia</p>

“…The level of MPV seems to have prognostic value in many types of solid tumorscolorectal cancer, gastric cancer, renal cell carcinoma, esophageal cancer, non-small cell lung cancer, invasive breast cancer or papillary thyroid carcinoma. [4][5][6][7][8][9][10][11] Single reports on the role of MPV in lymphoproliferative diseases could also be found in the literature. Low MPV values were related to worse outcome in patients with diffuse large B-cell lymphoma (DLBCL).…”

The prognostic impact of preoperative platelet distribution width-to-platelet count ratio in patients with bladder cancer

“…Larger platelets store more granules and receptors, and adhere faster than smaller platelets. Therefore, the activity of platelets is more accurately expressed by their size than by counting (11)(12)(13). The ratio of platelet distribution width to platelet count is a commonly used measurement of platelet size and an alternative indicator of platelet activation (14).…”