Pretreatment Thrombocytosis as a Prognostic Factor in Women with Gynecologic Malignancies: a Meta-analysis

  • Yu, Min (Department of Cancer Center, State Key Laboratory of Biotherapy) ;
  • Liu, Lei (Department of Cancer Center, State Key Laboratory of Biotherapy) ;
  • Zhang, Bing-Lan (Department of Cancer Center, State Key Laboratory of Biotherapy) ;
  • Chen, Qi (Department of Cancer Center, State Key Laboratory of Biotherapy) ;
  • Ma, Xue-Lei (Department of Cancer Center, State Key Laboratory of Biotherapy) ;
  • Wu, Yu-Ke (Department of Cancer Center, State Key Laboratory of Biotherapy) ;
  • Liang, Chun-Shui (Department of Cancer Center, State Key Laboratory of Biotherapy) ;
  • Niu, Zhi-Min (Department of Cancer Center, State Key Laboratory of Biotherapy) ;
  • Qin, Xin (Department of Cancer Center, State Key Laboratory of Biotherapy) ;
  • Niu, Ting (Department of Hematology, West China Hospital, Sichuan University)
  • Published : 2012.12.31


Background: This study was performed to analyze the prognostic implications of pretreatment or preoperative thrombocytosis in women with gynecologic malignancies. Material and Methods: We surveyed 2 medical databases, PubMed and EMBASE, to identified all relevant studies. A total of 14 (n=3,490) that evaluated the link between thrombocytosis and 5-year survival were included. REVMAN version 5.1 was used for our analysis and publication bias was evaluated using the Begg's funnel plot and tested by STATA 11.0. Risk ratios (RRs) with 95% confidence intervals (CIs) generated by the random effect model were used to assess the strength of any association. Results: 709(20.3%) of the 3,490 patients exhibited thrombocytosis (platelet counts > $400{\times}10^9/L$) at primary diagnosis, and their mortality was 1.62-fold higher compared with the others (RR=1.62, 95%CI=[1.28-2.05], p<0.0001). Thrombocytosis failed to have a stronger effect on the survival of advanced patients of stages III to IV in our study (n=478, RR=1.29, 95% CI=[1.13-1.48], p=0.0003), nor in women with cervical cancer in stage IB (n=1371, RR=1.73, 95% CI=[1.71-2.58], p=0.007). In addition, when adjusted for different carcinoma, it was associated with worse prognosis for all except the ones with vulvar cancer (n=201, RR=0.43, 95% CI=[0.14-1.29], p=0.13). Conclusions: This meta-analysis indicated that thrombocytosis might be associated with a worse prognosis for patients with gynecologic malignancies but without specificity or sensitivity for the ones in advanced stage. When adjusted for different gynecologic malignancies, it showed a significant effect on survival of all except vulvar cancers.


Thrombocytosis;gynecologic malignancies;meta;analysis;prognosis


  1. Trousseau A, Bazire V, Cormack J, et al (1867). Lectures on clinical medicine, delivered at the Hotel-Dieu. Paris. London: R. Hard-wicke.
  2. Zeimet AG, Marth C, Muller-Holzner E, et al (1994). Significance of thrombocytosis in patients with epithelial ovarian cancer. Am J Obstet Gynecol, 170, 549-54.
  3. Zeimet AG, Marth C, Mullner-Holzner E, et al (1993). Clinical relevance of reactive thrombocytosis in patients with ovarian cancer. Gynakol Geburtshilfliche Rundsch, 33, 217-8.
  4. Kuyumcuoglu U, Guzel AI, Celik Y, et al (2010). The association of preoperative thrombocytosis with prognostic factors in malign ovarian tumor. Eur J Gynarc Oncol, 31, 514-6.
  5. Lavie O, Comerci G, Daras V, et al (1999). Thrombocytosis in women with vulvar carcinoma. Gynecol Oncol, 72, 82-6.
  6. Lee M, Kim SW, Nam EJ, et al (2011). The impact of pretreatment thrombocytosis and persistent thrombocytosis after adjuvant chemotherapy in patients with advanced epithelial ovarian cancer. Gynecol Oncol, 122, 238-41.
  7. Li AJ, Madden AC, Cass I, et al (2004). The prognostic significance of thrombocytosis in epithelial ovarian carcinoma. Gynecol Oncol, 92, 211-4.
  8. Lopes A, Daras V, Cross PA, et al (1994). Thrombocytosis as a prognostic factor in women with cervical cancer. Cancer, 74, 90-2.<90::AID-CNCR2820740116>3.0.CO;2-0
  9. Lukas H, Klaus M, Ben L, et al (2000). Tumor anemia and thrombocytosis in patients with vulvar cancer. Tumor Biol, 21, 309-14.
  10. Menczer J, Schejter E, Geva D, et al (1998). Ovarian carcinoma associated thrombocytosis. Correlation with prognostic factors and with survival. Eur J Gynaecol Oncol, 19, 82-4.
  11. Nash GF, Turner LF, Scully MF, et al (2002). Platelets and cancer. Lancet Oncol, 3, 425-30.
  12. Nieswandt B, Hafner M, Echtenacher B, et al (1999). Lysis of tumor cells by natural killer cells in mice is impeded by platelets. Cancer Res, 59, 1295-330.
  13. Parmar MK, Torri V, Stewart L, et al (1998). Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med, 17, 2815-34.<2815::AID-SIM110>3.0.CO;2-8
  14. Qiu J, Yu Y, Fu Y, et al (2012). Preoperative plasma fibrinogen, platelet count and prognosis in epithelial ovarian cancer. J Obstet Gynaecol Res, 38, 651-7.
  15. Riess L (1872). Zur pathologischen anatomie des blutes. Arch Anat Physiol Wissensch Med, 39, 237-49.
  16. Rodriguez GC, Clarke-Pearson DL, Soper JT, et al (1994). The negative prognostic implications of thrombocytosis in women with stage IB cervical cancer. Obstetrics and Gynecology, 83, 445-8.
  17. Scholz HS, Petru E, Gucer F, et al (2000). Preoperative thrombocytosis is an independent prognostic factor in stage III and IV endometrial cancer. Anticancer Res, 20, 3983-5.
  18. Stone RL, Nick AM, McNeish IA, et al (2012). Paraneoplastic Thrombocytosis in ovarian cancer. N Engl J Med, 366, 610-8.
  19. Tamussino KF, Gucer F, Reich O, et al (2001). Pretreatment hemoglobin, platelet count, and prognosis in endometrial carcinoma. Int J Gynecol Cancer, 11, 236-40.
  20. Taucher S, Salat A, Gnant M, et al (2003). Impact of pretreatment thrombocytosis on survival in primary breast cancer. Thromb Haemost, 89, 1098-106.
  21. Tomita M, Shimizu T, Hara M, et al (2008). Prognostic impact of thrombocytosis in resectable non-small cell lung cancer. Interact Cardiovasc Thorac Surg, 7, 613-5.
  22. Altman DG (2001). Systematic reviews of evaluations of prognostic variables. BMJ, 323, 224-8.
  23. Borsig L (2008). The role of platelet activation in tumor metastasis. Expert Rev Anticancer Ther, 8, 1247-55.
  24. Cho DS, Kim SJ, Lee SH, et al (2011). Prognostic significance of preoperative C-reactive protein elevation andthrombocytosis in patients with non-metastatic renal cell carcinoma. Korean J Urol, 52, 104-9.
  25. De Jonge ET, Viljoen E, Lindeque BG, et al (1999). The prognostic significance of p53, mdm2, c-erbB-2, cathepsin D, and thrombocytosis in stage IB cervical cancer treated by primary radical hysterectomy. Int J Gynecol Cancer, 9, 198-205.
  26. Gucer F, Moser F, Tamussino K, et al (1998). Thrombocytosis as a prognostic factor in endometrial carcinoma. Gynecol Oncol, 70, 210-4.
  27. Gucer F, Tamussino K, Keil F, et al (2004). Thrombocytosis in Gynecologic Malignancies. Ant Res, 24, 2053-60.
  28. Gorelick C, Andikyan V, Mack M, et al (2009). Prognostic significance of preoperative thrombocytosis in patients with endometrial carcinoma in an inner-city population. Int J Gynecol Cancer, 19, 1384-9.
  29. Grimes DA, Schulz KF (2002). Bias and causal associations in observational research. Lancet, 359, 248-52.
  30. Gungor T, Kanat-Pektas M, Sucak A, et al (2009). The role of thrombocytosis in prognostic evaluation of epithelial ovarian tumors. Arch Gynecol Obstet, 279, 53-6.
  31. Gustavo Rodriguez (1994). Does thrombocytosis have any prognostic significance in cervical cancer? Gynecologic Oncology, 55, 325-7.
  32. Hayes DF, Isaacs C, Stearns V (2001). Prognostic factors in breast cancer: current and new predictors of metastasis. J Mamm Gland Biol Neo, 6, 375-92.
  33. Heras P, Hatzopoulos A, Kritikos N, et al (2010). Platelet count and tumor progression in gastric cancer patients. Scand J Gastroenterol, 45, 1005-6.
  34. Hernandez E, Heller PB, Whitney C, et al (1994). Thrombocytosis in surgically treated stage IB squamous Thrombocytosis in surgically treated stage IB squamous cell cervical carcinoma (A Gynecologic Oncology Group study). Gynecol Oncol, 55, 328-32.
  35. Hernandez E, Lavine M, Dunton CJ, et al (1992). Poor prognosis associated with thrombocytosis in patients with cervical cancer. Cancer, 69, 2975-7.<2975::AID-CNCR2820691218>3.0.CO;2-A
  36. Hernandez E, Donohue KA, Anderson LL, Heller PB, Stehman FB (2000). The significance of thrombocytosis in patients with locally advanced cervical Carcinoma: A Gynecologic Oncology Group Study. Gynecol Oncol, 78, 137-42.

Cited by

  1. Paraneoplastic thrombocytosis: the secrets of tumor self-promotion vol.124, pp.2, 2014,
  2. Thresholds and timing of pre-operative thrombocytosis and ovarian cancer survival: analysis of laboratory measures from electronic medical records vol.16, pp.1, 2016,
  3. Pretreatment thrombocytosis as a significant prognostic factor in malignant mesothelioma: a meta-analysis vol.28, pp.6, 2017,
  4. The clinicopathological and prognostic role of thrombocytosis in patients with cancer: A meta-analysis vol.13, pp.6, 2017,
  5. The prognostic role of pretreatment platelet-to-lymphocyte ratio as predictors in patients with colorectal cancer: a meta-analysis vol.11, pp.1, 2017,
  6. The pretreatment thrombocytosis may predict prognosis of patients with colorectal cancer: a systematic review and meta-analysis vol.11, pp.2, 2017,