Relationships Between Thrombcytosis And Non-Small Cell Lung Cancer: A Preliminary Study

Primary lung cancer is the leading cause of death in malignancis, in which about 85% is non-small cell lung cancer (NSCLC). Recently, several studies have reported that thrombocytosis is a concomitant in 10%～60% of overall malignancy patients and in 10%～32% of primary lung cancer patients approximately, which indicates poor prognosis. In this field the studies remain poor at present in China.ObjectivesTo explore the relationships between thrombcytosis and non-small cell lung cancer at the points of clinicopathologic characteristics, prognosis, bone metastasis, thrombo- embolic events and platinum-based chemotherapy.Material and methodsWe selected 523 cases with relatively complete clinical records from 758 cases with NSCLC who were admitted to Changhai hospital in 2003.7～2006.4, after cxcluded the patitents with other cancers, hematological diseases, rheumatic diseases, acute or chronic infection, and chronic inflammation diseases. After the follow-up visit including survival and bone metastasis and thromboembolic events, 308 cases remained at last. We divided the 308 cases into two groups according the blood platelet count at diagnosis, and retrospectively analyzed the clinical records by statistics software SPSS13.0. For counting data and rate, chi-square was used. For survival analysis, Cox model, Kaplan-Meier, life table and Log-Rankχ2 test are used. Binary Logistic regression model was used when we analyzed multiple factors of a binomial dependent variable. p<0.05 as significant cutoff.Results1. General condition.In 308 cases with NSCLC included, the general condition as follows: A. Age: 59.6±10.3 years old.B. Gender: male 213 cases (9.2%), female 95 cases (30.8%), the ratio between male and female is 2.2∶1.C. Diagnosis : postoperative 147 cases (47.7%), percutaneous lung puncture biopsy 96 cases (31.2%), bronchoscopic biopsy 65 cases (21.1%).D. Histological types: adenocarcinoma 180 cases (58.4%) including bronchioalveolar carcinoma ( BAC) 21 cases and adenocarcinoma with BAC component 28 cases, squamous carcinoma 120 cases (39.1%), adenosquamous carcinoma 6 cases (1.9%) and large cell carcinoma 2 cases(0.6%).E. TNM stage:Ⅰ71 cases (23.0%),Ⅱ33 cases (10.7%),ⅢA 43 cases (14.0%),ⅢB 49 cases (15.9%) andⅣ112 cases (36.4%).F. In 308 NSCLC patients, the median survival time is 94.0w(3.6-299.0),the survival rates of one year and were 76.0% and 31.5%,respectively。G. Blood platelet count at diagnosis: (246.8±91.9)×109/L; subnormal 4 cases(1.3%), normal 222 cases (72.1%), above normal 82 cases (26.6%), and among them, mild elevation (300×109/L～350×109/L) 39 cases (47.6%), moderate elevation (350×109/L～400×109/L) 26 cases (31.7%) and severe elevation (≥400×109/L) 17 cases (20.7%).2. The relationships between thrombocytosis and clinical stages and histological types in NSCLC.In 308 cases with NSCLC, the frequencis of patients with thrombocytosis inⅠ,Ⅱ,ⅢA,ⅢB andⅣstage were 9 (12.7%), 10 (30.3%), 10 (23.3%), 16 (32.7%) and 37 (33.0%), respectively. There was linear relationship between the rates of NSCLC patients with thrombosytosis and their TNM stages (p<0.05), which prompts that the rate of patients with thrombocytosis would be higher in the population with advanced TNM stages.In the 308 NSCLC patients, the frequencis of patients with thrombocytosis at diagnosis in 180 cases with adenocarcinoma, 120 cases with squamouscarcinoma, 6 cases with adenosquamous carcinoma and 2 cases with large cell carcinoma were 45 (45/180, 25.0%), 34(34/120, 28.3%), 1(1/6, 16.7%) and 2(2/2, 100.0%), respectively. After analyzed the rates of patients with thromocytosis in each two histological types, we find the difference was not statistical significance(p>0.05), which suggests that thrombocytosis is not significantly related to histological types in NSCLC.3. The relationship between hrombocytosis and prognosis in NSCLC. Patients with thrombocytosis had a significantly poorer survival than those with normal platelet counts (MST: 60.7w VS 11.6w, one year survival rate:57.3% VS 82.7%,.three years survival rate: 12.2% VS 38.%, p<0.001).In a multivariate survival analysis (Cox model), the data of 209 cases in 308 were analyzed, and at last 7 factors at diagnosis remained in the model: thrombocytosis, ECOG PS≥2, advanced TNM stage, lower degree of differentiation , hypoalbuminaemia, elevation of lactic dehydrogenase and faster erythrocyte sedimentation were risk factors to overall survival time, indicating that thrombocytosis is a prognostic factor of poorer survival.4. The relationship between thrombocytosis and remote metastasis in NSCLC patients.In 308 cases with NSCLC, the most common matastasis sites and frequencies (from many to few) were lymphoid node 218 (70.8%), bone 138(44.8%),lung 93 (30.2%), brain 67 (21.8%), liver 46(14.9%), adrenal gland 11 (3.6%) and kidney 5 (1.6%).After compared the rates of metastasis in each site between the group with thrombocytosis and the group without thrombocytosis, and we found only bone metastasis was related to thrombocytosis in 308 NSCLC cases. The frequencis of patients with bone metastasis in the group with thrombocytosis and the group without thrombocytosis were 50 (50/82,61.0%) and 88 (88/226, 38.9%), respectively. After compared the rates of bone metastasis in the group with thrombocytosis with the other group, we found that thrombocytosis was significantly correlated with bone metastasis (p< 0.05), that is, the rate of bone metastasis in patients with thrombocytosis is higher than the rate in patients without thrombocyosis. The correlation coefficient between thrombocytosis and t bone metastasis is 0.336 (p<0.001).5. The relationship between thrombocytosis and episode of thromboemboism in NSCLC patients.There were fifteen (4.9%) records of thromboembolic events in the follow-up period in 308 NSCLC patients. In these fifteen cases, 12 cases (12/25.80.0%) were detected thrombocytosis, which is 9.2% of the frequency of thrombosytosis detected in the course of disease, and 3 cases (3/15,20.0%) without thrombocytosis, which is 1.7% of the frequency of thrombosytosis undetected in the course of disease.χ2 test was prefromed to compare the rate of thromboembolic events in the group with thrombocytosis with the rate of the other group. And there was statistically difference( p< 0.05) between these groups. Thrombocytosis is associated with thromboembolic events6. The relationship between thrombocytosis and therapeutic effect of platinum- based chemotherapy in NSCLC patientsIn 308 NSCLC cases, there were 137 patients acceptied platinum-based chemotherapy in their initial management. In these 137 patients, there were 40 cases (29.2%) with thrombocytosis and 97 (70.8%) without thrombocytosis. The mediun PFS, ORR, DCR and mediun OS are 20.9w, 12.5%, 42.5% and 49.6w in the group with thrombocytosis, and 25.7w, 32.0%, 63.9% and 94.7w in the group wtihout thrombocytosis, respectively. And there were significant differences laying in the ORR and DCR between the two groups( p< 0.05 ), excluding PFS. These prompted that therapeutic effect of platinum-based chemotherapy in NSCLC patients with thrombocytosis is poorer than that in those without thromboctosis .ConclusionIn this study, we retrospectively analyzed the clinical records of 308 cases with NSCLC, and preliminary studied the relationships between thrombcytosis and non-small cell lung cancer at the points of clinicopathologic characteristics, prognosis, bone metastasis, thromboembolic events and platinum-based chemotherapy. And the conclusion as followes:1. 26.6% of patients with NSCLC accompany with thrombocytosis in 308 cases.2. In NSCLC, thrombcytosis is associated with TNM stage: more advanced stage, more common thrombocytosis.3. The NSCLC patients with thrombocytosis have poorer prognosis than those without thrombocytosis4. Thrombocytosis is correlated with bone metastasis in patients with NSCLC: the rate of bone metastasis is higher in patients with thrombocytosis than that in those without thrombocytosis.5. There were 15 thromboembolic events in 308 NSCLC cases, 80% of patients accompanied with thrombocytosis in 15 cases. Thrombocytosis is correlated with thromboembolic events in patients with NSCLC.6. The therapeutic effect of platinum-based chemotherapy in NSCLC patients with thrombocytosis is poorer than that in those without thromboctosis.