Thrombocytosis portends adverse prognostic significance in patients with stage II colorectal carcinoma

Tianhua Guo; Marcin Krzystanek; Zoltan Szallasi; Arpad Szallasi

doi:10.12688/f1000research.4856.1

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Observation Article

Thrombocytosis portends adverse prognostic significance in patients with stage II colorectal carcinoma

[version 1; peer review: 2 approved with reservations]

Tianhua Guo¹, Marcin Krzystanek², Zoltan Szallasi^2,3, Arpad Szallasi¹

PUBLISHED 31 Jul 2014

Author details Author details

¹ Department of Pathology, Monmouth Medical Center, Long Branch, NJ, NJ 07740, USA
² Department of Systems Biology, Technical University of Denmark, Lyngby, 2800, Denmark
³ Children’s Hospital Informatics Program at the Harvard–Massachusetts Institute of Technology Division of Health Sciences and Technology, Harvard Medical School, Boston, MA, MA 02115, USA

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Abstract

Thrombocytosis portends adverse prognostic significance in many types of cancers including ovarian and lung carcinoma. In this study, we determined the prevalence and prognostic significance of thrombocytosis (defined as platelet count in excess of 400 K/μl) in patients with colorectal cancer. We performed a retrospective analysis of 310 consecutive patients diagnosed at our institution between 2004 and 2013. The patients (48.7% male and 51.3% female) had a mean age of 69.9 years (+/- 12.7 years) at diagnosis. Thrombocytosis was found in a total of 25 patients, with a higher incidence in those with stage III and IV disease (14.4% of patients). Although the mean platelet count increased with the depth of tumor invasion (pT), its values remained within normal limits in the whole patient cohort. No patient with stage I cancer (n=57) had elevated platelet count at diagnosis. By contrast, five of the 78 patients (6.4%) with stage II cancer showed thrombocytosis, and four of these patients showed early recurrence and/or metastatic disease, resulting in shortened survival (they died within one year after surgery). The incidence of thrombocytosis increased to 12.2% and 20.6%, respectively, in patients with stage III and IV disease. The overall survival rate of patients with thrombocytosis was lower than those without thrombocytosis in the stage II and III disease groups, but this difference disappeared in patients with stage IV cancer who did poorly regardless of their platelet count. We concluded that thrombocytosis at diagnosis indicates adverse clinical outcome in colorectal cancer patients with stage II or III disease. This observation is especially intriguing in stage II patients because the clinical management of these patients is controversial. If our data are confirmed in larger studies, stage II colon cancer patients with thrombocytosis should be upstaged and treated as stage III/IV disease patients.

Corresponding author: Arpad Szallasi

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2014 Guo T et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Data associated with the article are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication).

How to cite: Guo T, Krzystanek M, Szallasi Z and Szallasi A. Thrombocytosis portends adverse prognostic significance in patients with stage II colorectal carcinoma [version 1; peer review: 2 approved with reservations]. F1000Research 2014, 3:180 (https://doi.org/10.12688/f1000research.4856.1) First published: 31 Jul 2014, 3:180 (https://doi.org/10.12688/f1000research.4856.1) Latest published: 20 Oct 2014, 3:180 (https://doi.org/10.12688/f1000research.4856.2)

Introduction

Platelets play important roles in hemostasis, immunity and inflammation¹. Cancer is often associated with thrombocytosis². Thrombocytosis was reported as a poor prognostic indicator in many types of cancers including lung cancer³, renal cell carcinoma⁴ and gynecological cancers⁵. A positive correlation between the depth of tumor invasion and platelet counts was demonstrated in a gastric cancer study, and thrombocytosis served as an adverse prognostic factor in clinical outcome in gastric cancer patients⁶. Recent studies have shown that thrombocytosis in cancer may be correlated with serum cytokine levels that stimulate thrombopoiesis. For example, elevated plasma levels of IL-6 and thrombopoietin were reported in ovarian cancer patients⁵.

Colon cancer is a leading cause of cancer-related death in developed countries (http://seer.cancer.gov/statfacts/html/colorect.html). A significant portion of patients receiving potentially curative resection dies within five years of diagnosis⁷. Since both chemo- and radiation therapies cause very significant side-effects, it is critical to define reliable prognostic factors to identify patients who might benefit from more aggressive adjuvant treatment options. The prognostic role of thrombocytosis in colorectal cancer patients has not been fully investigated, although there are some reports supporting the negative impact of thrombocytosis on the survival of patients with colorectal cancer^8,9.

In this study, the aim was to analyze the association between platelet count at diagnosis or pre-surgery and cancer stage, and to determine the prognostic significance of thrombocytosis in patients with colorectal cancer.

Patients and methods

After approval by the Monmouth Medical Center Institutional Research Review Board (IRB Study # 213-041), the medical records of 310 consecutive colorectal cancer patients who underwent biopsy (47 patients), surgical resection and/or neoadjuvant treatment (263 patients) at our institution between 2004 and 2013 were retrospectively reviewed. The patient cohort included 62 patients with in-situ or stage I disease, 78 patients at stage II, 98 patients at stage III, 34 patients at stage IV, and 38 patients with biopsy diagnosis only (stage could not be determined). The mean age of the patients was 69.9±12.7 years (range = 32 to 98 years). The data gathered included platelet counts, tumor location, histological type, lymph node metastasis, depth of tumor invasion (T), presence or absence of distant metastasis, and survival time.

Pre-operative platelet counts were collected from our Laboratory Information System (LIS), and thrombocytosis was defined as platelet count ≥ 400 × 10³/μl. After resection of the tumor, all specimens were histologically examined by a pathologist and the pathological TNM stage was determined according to the American Joint Committee on Cancer, 7^th edition. Stage I and II cancers are lymph node negative (N0) whereas stage III is defined by the presence of lymph node metastasis. Patients with distant metastatic disease are classified as stage IV.

Survival data were provided by the Cancer Registry at the Leon Hess Cancer Center, Monmouth Medical Center. All calculations were made using R version 2.15.0 and packages “beeswarm”, “survplot”, “survival” and “stats”. Survival curves were generated using the Kaplan-Meier method. Hazard ratios with 95% confidence intervals were obtained using Cox proportional hazards regression. Long-rank test was used for the analysis of significance.

Results

The characteristics (including age, gender, pT stage, tumor differentiation and platelet count) of the patients in our study cohort are shown in Table 1. Of the 310 patients with colorectal cancer, 25 (8.1%) had thrombocytosis at diagnosis or pre-surgery with the highest incidence detected in stage IV patients (20.6%) [Table 2]. Importantly, none of the 57 patients with stage I carcinoma had elevated platelet count. Although the mean platelet count increased with the depth of invasion (pT), it remained within the normal limits in all patients groups (pT1 to pT4) [Figure 1]. Mean platelet counts (×10³/µL) were 216±71 (pT1), 252±83 (pT2), 274±109 (pT3), and 291±104 (pT4); this increase was significant at P = 0.001. By contrast, there were no significant differences in thrombocytosis with regard to gender, age, location, or tumor differentiation (data not shown).

Table 1. Patient characteristics.

	Number (%)
Total	310
Gender
Male	151 (48.7%)
Female	159 (51.3%)
Age	69.9±12.7 years^a
Pathologic category of primary tumor (pT)^b
pTis	5 (1.6%)
pT1	17 (5.5%)
pT2	60 (19.4%)
pT3	137 (44.2%)
pT4	44 (14.2%)
pTx (unclassified)	47 (15.2%)
Grade^c
well differentiated	42 (13.5%)
moderately differentiated	149 (48.1%)
poorly differentiated	67 (21.6%)
unclassified	52 (16.8%)
Platelet count (×10³/µL)
≥ 400	25 (8.1%)
< 400	285 (91.9%)

a: Data presented as mean ± SD; b: staging according to AJCC Cancer Staging Manual 7^th Edition); c: Grading according to WHO grading system

Table 2. Incidence of thrombocytosis in each stage of colorectal cancer.

	Number of cases with thrombocytosis	Number of cases without thrombocytosis	Total number of cases	% of thrombocytosis
Stage 0	0	5	5	0.0
Stage I	0	57	57	0.0
Stage II	5	73	78	6.4
Stage III	12	86	98	12.2
Stage IV	7	27	34	20.6
Stage X (unclassified)	1	37	38	2.6
Overall	25	285	310	8.1
*Stage IV and III combined	19	113	132	14.4

Note: There are 403 cases in our data pool. 310 cases were diagnosed as colon cancer among the 321 cases with available platelet counts (82 cases without platelet counts). 11 non-colorectal cancer cases including 5 cases labeled as “appendix” and 6 cases labeled as “not colon cancer” were taken out of the pool.

Figure 1. Mean platelet count according to the depth of tumor invasion.

The mean platelet count of patients with pT1, (216±71) × 10³/µL is significantly lower than patients with pT4 (291±104) × 10³/µL, P = 0.001.

The combined incidence of thrombocytosis in stage III and IV disease was 14.4%. Stage II disease had the lowest incidence (6.4%) and stage IV cancer showed the highest incidence of elevated platelet count (20.6%) [Table 2]. The overall survival of patients with stage I to stage III colorectal cancer with thrombocytosis was significantly lower than those without thrombocytosis [Figure 2]. Although patients with Stage IV carcinoma had the highest prevalence of thrombocytosis, these patients did uniformly poorly and the difference in survival was no longer observed in patients with or without elevated platelet count (not shown). Patients with thrombocytosis (PLT ≥ 400 × 10³/μL) at stage I to stage III had a hazard ratio of 2.2 compared to the patients without thrombocytosis (PLT < 400 × 10³/μL) as shown in Figure 2.

Figure 2. Overall survival plots of patients with stage I to stage III colorectal cancer according the preoperative platelet counts.

Patients were allocated into two groups: with thrombocytosis, PLT ≥ 400 × 10³/µL (labeled as Exceeds) and without thrombocytosis) PLT < 400 × 10³/µL (labeled as Normal). The patients with thrombocytosis have a hazard ratio of 2.2 compare to the patients without thrombocytosis (P<0.05).

Patient	Location	Location1	Gender	Platelets	Lymphocytes	Absolute lymphocytes	MSI	Stage	Grade	Date of Specimen	Column	Vital Status	Date of Last contact	Date of first encounter	Date of diagnosis	Age at diagnosis
1	Colon		F	224	1	1	None	T4N1	2	Jan-04		Dead	Feb-04	Jan-04	Dec-03	81
2	Right Colon		F	197	11	1	None	T2N0	Well differentiated	Jan-04		Dead	Feb-09	Jan-04	Nov-03	81
3	Left colon		F	213	23	1	None	T3N2	Moderately differentiated	Jan-04		Dead	Mar-07	Jan-04	Jan-04	35
4	Terminal ileum & colon	Right colon	M	152	54	2	None	T3N0	Well to moderately differentiated	Jan-05		Dead	Nov-05	Feb-05	Feb-05	58
5	Ascending colon	Right colon	F	263	12	1	None	None	None	Jan-04		Dead	Mar-04	Jan-04	Jan-04	91
6	Transverse colon		F	258	8	0	None	T3N2	Poorly differentiated	Feb-04		Dead	Sep-04	Feb-04	Dec-03	84
7	Liver with mets		M	298	25	2	None	None	None	Feb-04	Mets to liver - only specimen	Dead	May-05	Feb-04	Feb-04	79
8	Colon		M	426	12	1	None	None	Poorly differentiated signet ring adenocarcinoma	Feb-04	Signet ring	Alive	Aug-04	Feb-04	Feb-04	72
9	Ascending	Right colon	F	None	None	None	None	None	Moderately to poorly differentiated	Feb-04	Sigmoid biopsy is only specimen	Alive	Aug-11	Feb-04	Feb-04	68
10	Colon		M	332	18	1	None	None	Carcinoma in situ	2/5/2004 and 6/11/2004		Alive	Mar-13	Mar-04	Feb-04	49
11	Sigmoid	Left colon	M	254	37	6	None	None	None	Apr-04		Dead	Nov-04	Apr-04	Mar-04	72
12	Transverse and Descending Colon	Left colon	M	274	2	1	None	Intramucosal carcinoma	None	Apr-04		Dead	Dec-10	Apr-04	Apr-04	81
13	Right Colon		M	284	9	1	None	T3N0	Well to moderately differentiated	Apr-04		Dead	Oct-07	Apr-04	Apr-04	83
14	Descending Colon	Left colon	F	None	None	None	None	None	Moderately differentiated found in 2008 specimen	Apr-04		Dead	May-09	Apr-04	Apr-04	80
15	None		F	193	5	1	None	None	None	Apr-04	No cancer	Alive	Oct-12	Apr-04	Mar-04	78
16	Right Colon		M	344	23	2	None	T4N1V1	2	Feb-04		Dead	Jun-04	Apr-04	Apr-04	89
17	Right Colon		F	308	15	1	None	T3N0	Poorly differentiated	May-04		Dead	Mar-05	Apr-04	Apr-04	87
18	Right Colon		M	173	5	1	None	T3N0	2	May-04	focal mucinous differentiation	Alive	Nov-12	May-04	May-04	57
19	Right Colon		F	279	16	2	None	T3N1	2	Jun-04		Alive	Sep-06	Jun-04	Jun-04	74
20	Colon		M	None	None	None	None	T3N0	2	Jul-04		Alive	Dec-12	Jun-04	Jun-04	62
21	Sigmoid colon	Left colon	M	None	None	None	None	None	None	Jun-04		Alive	Dec-12	Jun-04	May-04	57
22	Sigmoid colon	Left colon	M	443	10	2	None	pT4N2M1	Poorly differentiated	Jul-04		Dead	Feb-06	Jun-04	Jul-04	77
23	Ascending colon	Right colon	F	364	33	2	None	T3N2M1	2	Jun-04		Dead	Jul-07	Jun-04	Jun-04	62
24	Left colon		M	262	10	1	None	T3N0	Well to focally moderately differentiated	Jun-04		Dead	Dec-07	Jun-04	Jun-04	81
25	Colon	Left colon	F	242	15	1	None	T3N0M1	Carcinoid	Jul-04	Carcinoid Tumor	Dead	Feb-06	Jul-04	Jul-04	77
26	Sigmoid		M	None	None	None	None	T4N0	Well differentiated	Jul-04	Mucinous	Alive	Dec-12	Jul-04	Jul-04	72
27	Hepatic flexure	Right colon	F	None	None	None	None	None	None	Jul-04		Alive	May-09	Jul-04	Jul-04	74
28	Rectosigmoid		M	220	18	2	None	None	None	Jul-04	Carcinoid	Alive	Jan-12	Jul-04	Jul-04	65
29	Rectosigmoid		F	174	10	1	None	T3N0MX	Moderately to poorly differentiated	Aug-04		Alive	Apr-13	Jul-04	Jul-04	68
30	Ascending colon	Right colon	F	None	None	None	None	None	None	Aug-04	Biopsy - only specimen	Alive	Mar-12	Aug-04	Aug-04	57
31	Sigmoid	Left colon	F	402	16	2	None	T4bN2M1	Well to moderately differentiated	Aug-04		Alive	Nov-12	Aug-04	Jul-04	81
32	Right colon		M	225	12	1	None	T1N0	Well differentiated	Oct-04		Alive	May-13	Sep-04	Sep-04	60
33	Colon		M	326	5	1	None	T3N1	Moderately differentiated	Sep-04		Dead	Jun-09	Sep-04	Sep-04	81
34	Sigmoid	Left colon	M	196	35	2	None	None	None	Sep-04		Dead	Sep-08	Sep-04	Sep-04	65
35	Right colon		M	380	2	0	None	T3N2	Moderately differentiated	Sep-04		Dead	Jun-05	Sep-04	Aug-04	84
36	Cecum and ascending	Right colon	M	646	3	1	None	T3N0, T3N1	Moderately diffentiated	Sep-04	with mucinous differentiated	Alive	Dec-12	Sep-04	Sep-04	44
37	Left colon		F	381	18	2	None	T1	Moderately differentiated	Oct-04		Alive	Nov-12	Oct-04	Aug-04	68
38	Right colon		F	211	7	1	None	T3N0	Moderately differentiated	Oct-04	focal mucinous component (20%)	Dead	May-11	Oct-04	Sep-04	78
39	Right colon		M	258	11	1	None	T4N2M1	Poorly differentiated	Nov-04		Dead	Aug-06	Nov-04	Oct-04	78
40	Cecum		F	160	9	1	None	T3N1	Moderately differentiated	Nov-04		Alive	Jul-12	Nov-04	Oct-04	81
41	Sigmoid	Left colon	M	179	2	1	None	T2N0	Well differentiated	Nov-04		Dead	Jul-10	Nov-04	Oct-04	81
42	Colon		F	443	14	2	None	T4bN2MX	Well differentiated	Dec-04		Dead	Feb-05	Dec-04	Dec-04	65
43	Rectosigmoid colon		M	169	16	2	None	T1N1	Well differentiated	Dec-04		Alive	Jan-13	Dec-04	Nov-04	57
44	Right colon		F	None	None	None	None	T3N0	Moderately to poorly differentiated	Jan-05		Alive	Apr-12	Jan-05	Jan-05	86
45	Cecum and ascending	Right colon	F	323	22	2	None	None	None	Feb-05		Alive	Sep-10	Feb-05	Feb-05	76
46	Appendix		F	302	28	2	None	None	None	Jan-05	Appendix with mucinous cysadenoma	Alive	Dec-12	Feb-05	Jan-05	61
47	Right colon		F	336	16	1	None	T2N0	Well differentiated	Feb-05		Alive	Dec-12	Feb-05	Feb-05	74
48	Colon, terminal ileum	Right colon	M	282	14	1	None	T3N0	Well to moderately differentiated	Mar-05		Dead	Dec-10	Mar-05	Mar-05	79
49	Colon		M	204	3	1	None	None	None	Mar-05	Leiomyosarcoma, not adenocarcinoma	Alive	Oct-12	Mar-05	Mar-05	67
50	Ascending colon	Right colon	M	135	15	2	None	T1N0MX	Well differentiated	Apr-05		Alive	Nov-12	Apr-05	Mar-05	67
51	Colon		M	198	10	1	None	T3N2MX	Well to moderately differentiated	Apr-05		Alive	Nov-12	Apr-05	Apr-05	62
52	Right colon		F	None	None	None	None	None	None	Mar-05		Alive	Sep-12	Apr-05	Mar-05	71
53	Proximal transverse colon		M	497	10	1	None	T3N1	Moderately differentiated	May-05		Alive	Nov-12	May-05	Apr-05	60
54	Right colon		M	None	None	None	None	T3N2MX	Poorly differentiated	Jun-05		Alive	Jun-13	May-05	May-05	80
55	Sigmoid colon	Left colon	F	164	10	1	None	T3N0	Moderately differentiated	Jun-05		Alive	Oct-12	Jun-05	May-05	77
56	Right colon		M	262	17	1	None	T3N1	Poorly differentiated	Jun-05		Dead	Apr-06	Jun-05	Mar-05	70
57	Hepatic flexure/ascending	Right colon	M	137	11	1	None	None	None	Jun-05		Dead	Oct-07	Jun-05	Jun-05	90
58	Right colon		M	494	9	1	None	T4N2	Moderately differentiated	Jun-05		Alive	Nov-10	Jun-05	May-05	79
59	Right colon		M	262	8	1	None	T3N1	Moderately differentiated	Jun-05		Alive	Aug-12	Jun-05	Jun-05	53
60	Right colon		M	163	5	1	None	T1	Well differentiated	Feb-05		Dead	Jun-05	Feb-05	Feb-05	90
61	Sigmoid colon		F	394	7	1	None	T3N2	Moderately differentiated	Jul-05		Dead	Mar-11	Jun-05	Jun-05	51
62	Ascending colon	Right colon	F	362	18	2	None	T3N0		Jun-05	extensive areas of mucinous differentiation	Alive	Dec-12	Jun-05	May-05	83
63	Right colon		M	175	19	1	None	T2N0	Well differentiated	Jun-05		Alive	Aug-12	Jun-05	Jun-05	73
64	Cecum	Right colon	M	None	None	None	None	T2N1	Well differentiated	Jul-05		Alive	Aug-12	Jun-05	Jun-05	85
65	Left colon		F	373	4	1	None	T3N0	Moderately differentiated	Jul-05		Dead	Jan-08	Jul-05	Jul-05	67
66	Ileocecal valve	Right colon	F	319	24	1	None	None	None	Jul-05	Biopsy only - Intramucosa carcinoma	Dead	Apr-06	Jul-05	Jul-05	95
67	Right colon		M	204	7	1	None	T2N0	2	Jul-05		Alive	Oct-11	Jul-05	Jun-05	68
68	Colon		F	189	3	0	None	T1	Well to moderately differentiated	Aug-05	with focal mucinous differentiation	Alive	Nov-12	Aug-05	Jun-05	59
69	Colon		M	230	4	1	None	T3N0 and T3N1	Moderately differentiated	Aug-05		Alive	May-13	Aug-05	Aug-05	80
70	Transverse		F	353	12	1	None	T2N2MX	Well to moderately differentiated	Aug-05		Dead	Nov-06	Aug-05	Apr-05	96
71	Right Colon		M	168	7	0	None	T3N1	Moderately differentiated	Aug-05		Alive	Mar-10	Aug-05	Jul-05	90
72	Left colon		F	144	2	1	None	T4N1	Moderately differentiated	Aug-05		Alive	Sep-10	Aug-05	Aug-05	53
73	Left extended sigmoid	Left colon	M	261	4	0	None	T3N2MX	Well to moderately differentiated	Sep-05		Dead	Apr-10	Aug-05	Aug-05	56
74	Liver mets		M	455	11	1	None	None	None	Aug-05		Dead	Sep-05	Aug-05	Aug-05	84
75	Right colon		M	362	1	1	None	T3N2M1		Sep-05		Dead	Oct-05	Aug-05	Sep-05	70
76	Right colon		F	229	6	1	None	T3N0	Moderately differentiated	Sep-05		Alive	Jan-13	Aug-05	Aug-05	37
77	Right colon		F	263	3	1	None	T3N1V1	Moderately differentiated	Sep-05		Dead	Jan-11	Sep-05	Sep-05	85
78	Ascending colon	Right colon	M	143	17	2	None	T2N1MX	Moderately to poorly differentiated	Sep-05	Focal mucinous differentiation	Alive	Jan-13	Sep-05	Sep-05	53
79	Right colon		M	179	33	1	None	T3N0	Moderately differentiated	Sep-05	Tubular adenoma	Alive	Aug-12	Sep-05	Sep-05	56
80	Right colon, cecum		F	86			None					Dead	Nov-05	Sep-05	Sep-05	81
81	Sigmoid	Left colon	M	377	14	1	None	None	Well differentiated	Oct-05		Dead	Nov-05	Oct-05	Oct-05	78
82	Large intestine, 20 cm		F	290	25	1	None	None	None	Oct-05		Alive	Nov-12	Oct-05	Oct-05	41
83	Sigmoid		M	245	8	1	None	T3N0	2	Oct-05		Alive	Mar-13	Oct-05	Sep-05	60
84	Left colon		F	327	2	1	None	T3N0	Moderately differentiated	Oct-05		Alive	Nov-12	Oct-05	Sep-05	73
85	Proximal transverse colon		M	136	27	2	None	None	None	Dec-05	Intramucosal carcinoma	Dead	Apr-08	Oct-05	Oct-05	98
86	Right colon		F	294	24	1	None	T3N0	Moderately to poorly differentiated	Oct-04		Alive	Nov-12	Oct-05	Sep-05	74
87	Left colon		F	231	25	2	None	None	None	Oct-05	Carcinoid tumor	Alive	Dec-12	Oct-05	Sep-05	66
88	Right colon		M	228	8	1	None	T2N0	Moderately differentiated	Nov-05	70% mucinous differentiation	Alive	Nov-12	Nov-05	Nov-05	76
89	Colon		M	357	12	1	None	T2N0	Well differentiated	Dec-05		Alive	Nov-12	Dec-05	Dec-05	50
90	Appendix		M	264	16	1	None	None	None	Dec-05	Superficially invasive mucinous adenocarcinoma	Alive	May-12	Dec-05	Dec-05	51
91	Sigmoid, Right Colon		M	None	None	None	None	T4N2MX	Well to moderately differentiated	Jan-06	mucinous (colloid)	Dead	Jan-07	Jan-06	Jan-06	66
92	Right colon/cecum		F	188	13	1	None	T2N0	Well differentiated	Jan-06		Alive	Oct-11	Jan-06	Jan-06	82
93	Transverse		F	458	14	1	None	T3N1	Moderately differentiated	Jan-06		Alive	Nov-12	Jan-06	Jan-06	83
94	Colon		F	276	13	1	None	T2N1MX	Well differentiated	Feb-06	with mucin production/colloid carcinoma	Alive	Dec-12	Feb-06	Nov-05	50
95	Left colon		F	577	2	2	None	T3N1	Moderately differentiated	Mar-06		Dead	Jun-06	Mar-06	Feb-06	73
96	Left colon		F	353	7	1	None	T3N0MX	Well to moderately differentiated	Mar-06		Dead	Sep-07	Mar-06	Mar-06	89
97	Metastatic to ovaries, abdominal wall, omentum		F	517	3	0	None	None	None	Mar-06		Dead	Jul-06	Mar-06	Mar-06	54
98	Left colon		F	234	5	0	None	T3N1MX	Moderately differentiated	Apr-06		Dead	Aug-11	Apr-06	Apr-06	48
99	Rectosigmoid		M	216	4	0	None	T3N2		Jun-06		Dead	Feb-08	Apr-06	Apr-06	50
100	Left colon		F	None	None	None	None	T4N1		Jun-06		Dead	Mar-09	May-06	May-06	59
101	Sigmoid	Left colon	M	190	3	0	None	T2N0	Moderately differentiated	Jul-06		Alive	Oct-11	May-06	May-06	72
102	Transverse colon		F	276	4	1	None	T3N0MX	Well to moderately differentiated	May-06		Alive	Feb-13	May-06	May-06	82
103	Right colon		M	None	None	None	None	T2N0		Jun-06	mucinous	Alive	Dec-12	Jun-06	May-06	38
104	Transverse and left colon/splenic flexure	Left colon	M	344	12	1	None	T3N2	Poorly differentiated	Jun-06		Dead	Jun-06	Jun-06	Jun-06	77
105	Sigmoid	Left colon	F	226	20	1	None	T2N0	Moderately differentiated	Jun-06	Two tumors in 2008, T2N0 and T1N), moderately and well to moderately differentiated	Alive	Nov-12	Jun-06	Jun-06	73
106	Right colon/cecum		F	313	6	1	None	T4N2	Poorly differentiated	Mar-06		Alive	Nov-12	Jun-06	Jun-06	69
107	Right colon		F	202	13	1	None	T3N0	Moderate differentiated	Jul-06		Alive	Nov-12	Jul-06	Jun-06	69
108	Cecum	Right colon	F	369	1	1	None	None	None	Jul-06	focally mucinous - biopsy only	Dead	Jan-07	Jul-06	Jul-06	81
109	Sigmoid	Left colon		None	None	None	None	T1N1MX	Well differentiated	Aug-06	mucinous differentiation	Alive	Jun-12	Jul-06	Jul-06	61
110	Right colon/cecum		F	296	20	2	None	T3N0	Well to moderately differentiated	Jul-06	with mucinous features	Alive	Nov-12	Jul-06	Jun-06	86
111	Hepatic flexure/ascending	Right colon	M	168	18	1	None	None	None	Jul-06	not a resection specimen - mass	Dead	Jun-08	Jul-06	Jul-06	85
112	Right colon		F	None	None	None	None	T2N0MX	Well differentiated	Aug-06	mucinous/ colloid	Alive	Jan-13	Aug-06	Aug-06	65
113	Cecum and appendix	Right colon	M	304	5	1	None	(T3/T4)NXMX	Well differentiated	Sep-06	appendiceal origin	Alive	Nov-11	Aug-06	Sep-06	68
114	Cecum	Right colon	M	220	14	1	None	T3N1MX	Well differentiated	Aug-06		Alive	Feb-13	Aug-06	Jul-06	67
115	Colon		M	None	None	None	None	T4N2	Moderately differentiated	Aug-06		Dead	Nov-08	Aug-06	Aug-06	58
116	Right colon		F	298	9	1	None	T3N0MX	Moderately differentiated	Sep-06		Alive	Nov-12	Sep-06	Aug-06	81
117	Sigmoid	Left colon	F	279	5	1	None	T4N2		Oct-06		Dead	Jun-08	Sep-06	Oct-06	73
118	Ascending colon	Right colon	F	210	8	1	None	T3N1	Moderately differentiated	Oct-06		Alive	Mar-13	Oct-06	Sep-06	57
119	Transverse colon		F	321	17	2	None	T3N2	2 and 3 / 3	Oct-06		Dead	Dec-07	Oct-06	Oct-06	74
120	Rectal		F	89	48	5	None	T1NO	Moderately differentiated	Oct-06		Alive	Nov-12	Oct-06	Oct-06	81
121	Supraclavicular l.n.		M	245	22	1	None	None	Poorly differentiated	Nov-06		Dead	Aug-10	Oct-06	Oct-06	71
122	Right colon		F	566	7	1	None	T3N0	Poorly differentiated	Nov-06		Alive	Dec-12	Nov-06	Oct-06	69
123	Transverse colon neuroendocrine		F	326	7	1	None	T3N2M1 with liver mets	3/3, moderately differentiated neuroendocrine	Jan-07	3/3 and moderately differentiated disparity	Dead	Jan-07	Dec-06	Dec-06	65
124	Transverse colon		F	114	18	1	None	None	None	Dec-06	Intramucosal carcinoma	Alive	Nov-12	Dec-06	Nov-06	63
125	Rectosigmoid		F	243	24	1	None	T2N1	Moderately differentiated	Dec-06		Alive	Jun-12	Dec-06	Dec-06	72
126	Left colon		F	None	None	None	None	T3N1	Poorly differentiated	Feb-07		Dead	Jan-10	Feb-07	Feb-07	78
127	Right colon		M	103	16	1	None	T2N0	Moderately differentiated	Feb-07	Focal mucinous component	Alive	Nov-12	Feb-07	Feb-07	86
128	Rectosigmoid		F	171	6	1	None	No info	None	Mar-07	Tattoos only	Alive	Nov-12	Mar-07	Dec-06	74
129	Right colon		F	411	6	1	None	T3N1Mx	Moderately to poorly differentiated	Mar-07	focal mucinous and signet ring differentiation	Dead	Mar-07	Mar-07	Jan-07	90
130	Sigmoid colon	Left colon	M	189	3	0	None	High grade dysplasia	None	Mar-07	TA with high grade dysplasia only	Alive	Apr-12	Mar-07	Jan-07	69
131	Rectosigmoid		M	240	17	2	None	T2N0	Moderately differentiated	Jun-07		Alive	Nov-12	Apr-07	Apr-07	45
132	Ascending colon	Right colon	F	516	2	17	None	T3N2	Moderately differentiated	Apr-07		Alive	Jul-12	Apr-07	Mar-07	44
133	Right colon		M	323	9	1	None	T2N0	2 focal 3	May-07		Alive	Nov-12	Apr-07	Apr-07	68
134	Right colon		F	126	16	2	None	T2N2	N/A	May-07		Alive	Apr-12	May-07	May-07	64
135	Appendix		F	251	11	1	None	N/A	N/A	May-07		Alive	Jan-13	Apr-07	Apr-07	66
136	Right colon, hepatic flexure		M	150	35	2	None	T3N2	Moderately differentiated	Apr-07		Alive	May-13	Apr-07	Apr-07	72
137	Colon		F	313	10	1	None	T3N0MX	Well differentiated	May-07		Alive	Aug-12	May-07	Apr-07	68
138	Right colon		M	282	10	2	None	T2N0	Well differentiated	May-07		Alive	Nov-11	May-07	May-07	52
139	Right colon		M	107	7	1	None	High grade dysplasia	N/A	Jun-07		Alive	Nov-12	Jun-07	Jun-07	59
140	Transverse colon		M	342	24	2	None	T3N0	2,3	Jun-07		Dead	Jul-07	Jun-07	Jun-07	67
141	Right colon		M	283	17	10	None	T4N2		Jul-07		Dead	Aug-07	Jul-07	Jul-07	72
142	Right colon		F	364	6	1	None	T3N0	Moderately differentiated	Aug-07		Alive	Dec-12	Aug-07	Aug-07	59
143	Left colon		M	508	26	3	None	T3N1	2	Aug-07		Dead	Jul-11	Aug-07	Jul-07	73
144	Cecum	Right colon	F	255	38	1	None	T3N0	Poorly differentiated	Sep-07		Dead	Nov-07	Sep-07	Sep-07	87
145	Sigmoid	Left colon	F	None	None	None	None	T2N0	Moderately differentiated	Nov-07		Dead	Jan-10	Sep-07	Sep-07	75
146	Rectosigmoid		F	398	8	1	None	T2N0	Moderately differentiated	Sep-07		Alive	May-12	Sep-07	Sep-07	79
147	Left colon		F	None	None	None	None	T1N0MX	Well to moderately differentiated	Nov-07		Alive	Apr-13	Oct-07	Aug-07	72
148	Right colon		M	None	None	None	None	T3N1	2	Nov-07		Dead	Jan-10	Nov-07	Nov-07	86
149	Rectal sigmoid		F	336	10	1	None	T3N2MX	well differentiated	Nov-07		Alive	Nov-12	Nov-07	Nov-07	68
150	Sigmoid	Left colon	M	246	12	1	None	None	Moderately differentiated	Nov-07		Dead	Apr-08	Nov-07	Nov-07	52
151	Rectal sigmoid		F	155	11	1	None	T2N1	well to moderately differentiated	Dec-07		Alive	Jun-13	Nov-07	Nov-07	70
152	Transverse colon		M	325	29	2	None	T2N0MX	Well differentiated	Dec-07		Alive	Nov-12	Nov-07	Nov-07	63
153	Right colon		F	None	None	None	None	T3N0MX	Moderately diffentiated	Jan-08		Dead	Jun-09	Dec-07	Dec-07	81
154	Rectosigmoid		M	518	11	18	None	T4N1	High grade	Dec-07		Dead	Jul-11	Dec-07	Dec-07	64
155	Right colon		F	207	62	2	None	T3N1	Intermediate to poorly differentiated	Dec-07		Alive	Jun-13	Dec-07	Dec-07	64
156	Right colon		M	343	11	1	None	T3N0	Moderately differentiated	Dec-07		Alive	Oct-12	Dec-07	Nov-07	79
157	Right colon		F	None	None	None	None	TisN0	1	Jan-08		Alive	Jun-13	Jan-08	Jan-08	61
158	Rectosigmoid		M	224	5	None	None	T3N2	2,3	Jan-08		Alive	May-13	Jan-08	Dec-07	44
159	Right colon		F	197	8	1	None	T4N1	Poorly differentiated	Feb-08		Dead	Apr-08	Feb-08	Feb-08	64
160	Transverse colon		M	210	8	1	None	T3N0	Moderately differentiated	Feb-08		Alive	Nov-12	Feb-08	Jan-08	65
161	Left colon		M	None	None	None	None	T3N1	Moderately differentiated	Feb-08		Dead	Jun-11	Feb-08	Feb-08	82
162	Right colon		F	238	35	2	None	T3N0MX	Moderately differentiated	Feb-08		Dead	Jun-09	Feb-08	Feb-08	69
163	Sigmoid	Left colon	F	287	9	1	MSh2, MLH1, MSH6 present	T2N1	2	Feb-08		Alive	May-13	Feb-08	Jan-08	54
164	Sigmoid and rectum	Left colon	M	427	23	2	None	T4N0	Moderately to poorly differentiated	Feb-08		Dead	Mar-09	Feb-08	Feb-08	73
165	Cecum	Right colon	M	281	8	1	None	T1N0MX	Moderately differentiated	Jan-08		Dead	Apr-08	Feb-08	Feb-08	71
166	Metastatic - Portahepatis		M									Dead	Dec-09	Feb-08	Feb-08	60
167	Metastatic to liver		F	246	11	1	None	Mets to liver	N/A	Mar-08		Dead	Dec-09	Mar-08	Feb-08	61
168	Ascending and Proximal Transverse Colon	Right colon	M	340	3	1	None	T3N0	Moderately differentiated	Mar-08		Dead	Apr-08	Mar-08	Mar-08	80
169	Left colon		M	298	18	2	None	T2N0	Moderately differentiated	Apr-08		Alive	Nov-12	Apr-08	Mar-08	71
170	Right colon		F	370	6	1	None	T2N0	2	Apr-08		Alive	Feb-12	Apr-08	Mar-08	85
171	Right colon		M	302	32	2	None	TisN0	well differentiated	Apr-08		Alive	Nov-12	Apr-08	Mar-08	74
172	Appemdix		M	192	9	1	None	None	well differentiated	Apr-08		Alive	Jun-11		Apr-08	49
173	Left colon		M	294	6	1	None	T2N2	Moderately differentiated	Apr-08		Alive	Nov-12	Apr-08	Apr-08	46
174	Cecum		M	None	None	None	None	T4N1	Moderately differentiated	Apr-08		Alive	Nov-12	Apr-08	Apr-08	78
175	Right colon		M	189	21	1	None	T3N0MX	2	May-08		Dead	Aug-10	May-08	May-08	87
176	Right colon		M	519	16	2	None	T3N2M1	moderately diffentiated	May-08		Alive	Feb-13	May-08	Apr-08	69
177	Right colon		M	207	13	1	None	T3pN0MX	well to moderately differentiated	Jun-08		Alive	Oct-12	May-08	Jun-08	81
178	Appendix		F	232	29	2	None	T4pN0MX	well differentiated	Jun-08		Alive	Apr-13	Jun-08	Jun-08	52
179	Colon		M	296	5	0	None	T3pN2Mx	well to moderately differentiated	Jun-08		Dead	Sep-09	Jun-08	Jan-08	71
180	Colon		F	None	None	None	None	T4N2	2	Jul-08		Alive	Apr-13	Jul-08	Jul-08	60
181	Rectosigmoid		M	210	8	1	None	T3N0	Poorly differentiated	Jul-08		Dead	Dec-11	Jul-08	May-08	64
182	Right colon		F	255	17	2	None	T4N2Mx	Moderately to poorly differentiated	Aug-08		Dead	Aug-08	Jul-08	Mar-08	53
183	Right colon		M	379	15	1	Partial loss of MSH6 (60%), MSH2 and MLH1 present	T2N2M1	Poorly differentiated	Aug-08		Dead	Nov-08	Aug-08	Jul-08	73
184	Right colon		F	300	27	2	None	T3N0	Poorly differentiated	Sep-08		Dead	Dec-09	Sep-08	Aug-08	65
185	Right colon		F	193	11	1	None	T2	Well to moderately differentiated	Sep-08		Dead	Nov-11	Sep-08	Sep-08	81
186	Rectosigmoid		F	247	5	1	None	T3N1	Well differentiated	Sep-08		Alive	Mar-13	Sep-08	Sep-08	64
187	Sigmoid	Left colon	M	None	None	None	None	T3N0	Moderately differentiated	Nov-08		Alive	May-13	Oct-08	Oct-08	70
188	Left colon		M	363	22	1	None	T2N0	Moderately differentiated	Nov-08		Alive	Nov-12	Nov-08	Nov-08	47
189	Sigmoid	Left colon	F	226	20	1	None	T2N0	Moderately differentiated	Jun-06		Alive	Nov-12	Nov-08	Oct-08	75
190	Colon		M	273	9	1	No MSI by PCR	T2N0	Moderately differentiated	Dec-08		Alive	Dec-12	Dec-08	Oct-08	47
191	Right colon		F	212	11	1	None	TisN0	Well differentiated	Dec-08		Alive	Dec-11	Dec-08	Oct-08	60
192	Hepatic flexure	Right colon	M	None	None	None	None	T1	None	Dec-08		Alive	May-12	Dec-08	Dec-08	80
193	Transverse colon		F	249	13	1	None	T3N0MX	Well to moderately differentiated	Dec-08		Alive	Nov-11	Dec-08	Dec-08	87
194	Ascending colon	Right colon	F	226	2	0	Focal absence of MSH6, no MSH2 or MLH1	T3N2	Moderately differentiated	Dec-08		Alive	Nov-12	Dec-08	Nov-08	78
195	Right colon		F	224	14	1	Focally absent MLH1 and MSH6, MSH2 present	T3N1	Moderately to poorly differentiated	Dec-08		Alive	Jun-13	Dec-08	Dec-08	65
196	Right colon		M	300	23	1	MSH2 and MLH1 present, MSH6 not tested	T3N2	Poorly differentiated	Jan-09		Alive	May-13	Jan-09	Jan-09	73
197	Large intestine		M	None	None	None	None	T2pN0MX	Well to moderately differentiated	Feb-09		Alive	Jan-13	Jan-09	Jan-09	87
198	Left colon		F	305	19	1	None	T2N0	Moderately differentiated	Jan-09		Alive	Oct-11	Jan-09	Jan-09	79
199	Colon		F	417	1	1	None	T4N0	High grade anaplastic suggesting neuroendocrine	Feb-09		Dead	May-09	Jan-09	Jan-09	82
This is a portion of the data; to view all the data, please download the file.

Dataset 1.Data of thrombocytosis in colon cancer patients.

This data set contains the medical records of patients diagnosed with colon cancer at the Monmouth Medical Center between 2004 and 2013.

Discussion

It was noted more than 100 years ago that thrombocytosis is often seen in patients with malignant diseases. Indeed, thrombocytosis correlates with both worse disease free survival and shortened overall survival in patients with ovarian cancer³, and worsens overall survival in patients with gastric cancer (reviewed in 10). The prognostic significance of thrombocytosis in colorectal cancer, however, remains controversial¹¹, although the majority of literature suggests a negative impact of thrombocytosis on the survival of patients with colorectal cancer^8,9.

In the present study, we identified a mild, T stage-dependant increase in mean platelet counts in patients with colorectal carcinoma that reached statistical significance when comparing T1 to T4; however, the mean platelet count remained within the normal limits in the whole patient cohort. Importantly, thrombocytosis was more common among patients with advanced disease: its prevalence increased from 6.4% in stage II to 20.6% in stage IV cancer patients. Our data are comparable to those reported in the literature (12.1–13.9%;^6,7).

In our study, thrombocytosis showed adverse prognostic significance in patients with stage I to stage III colorectal carcinoma; this was no longer apparent in patients with stage IV disease, presumably because these patients did poorly regardless of the platelet count.

Probably the most intriguing observation of our study is the fairly uniformly dismal clinical outcome of stage II patients with thrombocytosis (five out of 78 patients): four of these five patients did very poorly (they died within a year) and the fifth was lost to follow-up. We suspect that these cases might represent stage III/IV cases misclassified as stage II due to false negative lymph node examination. At present, the National Comprehensive Cancer Network guidelines do not recommend routine administration of adjuvant chemotherapy to stage II colorectal cancer patients whose cancer was completely resected¹². If our data are confirmed in future larger studies, stage II colorectal cancer patients with thrombocytosis should be upstaged and treated clinically as stage III/IV.

The molecular mechanisms underlying thrombocytosis in cancer patients are incompletely understood. Recently, plasma levels of IL-6 and thrombopoietin were found to significantly correlate with platelet counts in ovarian cancer patients. Indeed, silencing of the IL-6 and thrombopoietin genes markedly abrogated thrombocytosis (and halted tumor progression) in a mouse model of epithelial ovarian cancer⁵. These findings are promising because an anti-IL-6 agent (siltuximab) has already been approved by the United States Food and Drug Administration (FDA) to treat patients with Castleman’s disease (http://www.cancer.org//cancer/new/fda-approves-sylvant-siltuximab-for-castleman-disease). Another series of study showed that immobilized platelets support human colon carcinoma cell tethering, rolling, and firm adhesion under dynamic flow conditions in colon cancer cell lines, suggesting a role of platelets in hematogenous dissemination of tumor cells in colorectal cancer¹³. Taken together, these studies imply that inhibition of thrombocytosis may represent a potential novel target in cancer therapy.

In summary, thrombocytosis appears to herald adverse clinical outcome in patients with stage II and III colorectal carcinoma. We suggest that elevated platelet count may identify a subset of patients with stage II colon cancer who could benefit from close follow-up and aggressive adjuvant therapy.

Data availability

F1000Research: Dataset 1. Data of thrombocytosis in colon cancer patients, 10.5256/f1000research.4856.d33371¹⁴

Author contributions

Tianhua Guo: collected data.

Marcin Krzystanek: analysed data.

Zoltan Szallasi: initiated project, supervised data analysis.

Arpad Szallasi: supervised project, prepared MS.

All authors revised the manuscript and agreed to the final content.

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this study.

Faculty Opinions recommended

References

1. Michelson AD (ed): Platelets. Academic Press, Ebook. 2011. Reference Source
2. Lin RJ, Afshar-Khargan V, Schafer AI: Paraneoplastic thrombocytosis: the secrets of tumor self-promotion. Blood. 2014; 124(2): 184–187. PubMed Abstract | Publisher Full Text
3. Costatini V, Zacharski LR, Moritz TE, et al.: The platelet count in carcinoma of the lung and colon. Thromb Haemost. 1990; 64(4): 501–505. PubMed Abstract
4. Symbas NP, Townsend MF, El-Galley R, et al.: Poor prognosis associated with thrombocytosis in patients with renal cell carcinoma. BJU Int. 2000; 86(3): 203–207. PubMed Abstract | Publisher Full Text
5. Stone RL, Nick AM, McNeish IA, et al.: Paraneoplastic thrombocytosis in ovarian cancer. N Eng J Med. 2012; 366(7): 610–618. PubMed Abstract | Publisher Full Text | Free Full Text
6. Ikeda M, Furukawa H, Imamura H, et al.: Poor prognosis associated with thrombocytosis in patients with gastric cancer. Ann Surg Oncol. 2002; 9(3): 287–291. PubMed Abstract
7. McArdle CS, Hole DJ: Outcome following surgery for colorectal cancer. Br Med Bull. 2002; 64: 119–125. PubMed Abstract | Publisher Full Text
8. Sasaki K, Kawai K, Tsuno NH, et al.: Impact of preoperative thrombocytosis on the survival of patients with primary colorectal cancer. World J Surg. 2012; 36(1): 192–200. PubMed Abstract | Publisher Full Text
9. Kandemir EG, Mayadagli A, Karagoz B, et al.: Prognostic significance of thrombocytosis in node-negative colon cancer. J Int Med Res. 2005; 33(2): 228–235. PubMed Abstract | Publisher Full Text
10. Voutsadakis IA: Thrombocytosis as a prognostic marker in gastrointestinal cancers. World J Gastrointest Oncol. 2014; 6(2): 34–40. PubMed Abstract | Publisher Full Text | Free Full Text
11. Nyasavajjala SM, Runau F, Datta S, et al.: Is there a role for pre-operative thrombocytosis in the management of colorectal cancer? Int J Surg. 2010; 8(6): 436–438. PubMed Abstract | Publisher Full Text
12. Engstrom PF, Arnolett JP, Benson AB 3rd, et al.: NCCN Clinical Practice Guidelines for Oncology: colon cancer. J Natl Compr Canc Netw. 2009; 7(8): 778–831. PubMed Abstract
13. McCarty OJ, Mousa SA, Bray PF, et al.: Immobilized platelets support human colon carcinoma cell tethering, rolling, and firm adhesion under dynamic flow conditions. Blood. 2000; 96(5): 1789–1797. PubMed Abstract
14. Guo T, Krzystanek M, Szallasi Z, et al.: Data of thrombocytosis in colon cancer patients. F1000Research. 2014. Data Source

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Version 2

VERSION 2 PUBLISHED 31 Jul 2014

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The author(s) declared that no grants were involved in supporting this work.

Article Versions (2)

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Published: 20 Oct 2014, 3:180

https://doi.org/10.12688/f1000research.4856.2

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Published: 31 Jul 2014, 3:180

https://doi.org/10.12688/f1000research.4856.1

© 2014 Guo T et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Data associated with the article are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication).

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Guo T, Krzystanek M, Szallasi Z and Szallasi A. Thrombocytosis portends adverse prognostic significance in patients with stage II colorectal carcinoma [version 1; peer review: 2 approved with reservations] F1000Research 2014, 3:180 (https://doi.org/10.12688/f1000research.4856.1)

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Reviewer Report 06 Oct 2014

Judit Moldvay, Department of Pulmonology, Semmelweis University, Budapest, Hungary

Approved with Reservations

https://doi.org/10.5256/f1000research.5184.r6229

It is an interesting work providing new information on the issue of thrombocytosis in colon cancer patients. It contains relevant clinicopathologic parameters, however, there is no data on ethnicity, smoking habits, inflammatory processes, comorbidities, or medications of the studied patients, all which might have impact on platelet count (Msaouel et al., 2014).

The main factors that can influence the platelet count should at least be discussed.

In Figure 1. the Authors discussed the mean platelet count according to the depth of tumor invasion. Although it might change statistically significantly, the mean platelet count remains much within the normal range, therefore, the conclusion that “… we identified a mild, T stage-dependant increase in mean platelet count …” is not well-founded.

One of the most critical aspects of the investigation is the number of patients, especially in stage II, as disproportionately firm conclusions have been drawn regarding correlation between overall survival and thrombocytosis on the basis of only four patients with thrombocytosis in stage II.

Another weakness of the study is the lack of information on the precise localizations of the primary tumors, as this in itself may be of prognostic value, e.g. Majek et al. (2012) .

Although neoadjuvant treatment has been mentioned, it was not discussed in details, similarly, adjuvant treatments in advanced cases were not detailed either.These issues should be discussed in the "Discussion".

In Figure 2. the value of HR is not in accordance with the HR in the legend.

In the 4^th line of the Discussion there is a mistake with the Ref. 3., this – most probably – is the Ref. 5.

Similarly, in the 18^th line of the Discussion the Ref. 6. – most probably – is the Ref. 8.

In conclusion, this study yielded clinically very interesting results that might have therapeutic consequence, however, these results need to be confirmed in a much larger cohort of colorectal patients.

All in all, in my opinion this manuscript is acceptable for indexation, but only after corrections and completions based on the above mentioned comments.

Competing Interests: No competing interests were disclosed.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Author Response 13 Oct 2014

Arpad Szallasi, Department of Pathology, Monmouth Medical Center, Long Branch, NJ, NJ 07740, USA

13 Oct 2014

Author Response
Whereas we share some of the reservations of the referee, we would like to point out that this is an Observational Study and not a full report. We believe that ... Continue reading
Whereas we share some of the reservations of the referee, we would like to point out that this is an Observational Study and not a full report. We believe that despite the limitations of this study, this is an interesting observation with potential implications for patient management. That said, we wholeheartedly agree with the referee that "these results need to be confirmed in a much larger cohort of colorectal patients."

Changes done in response to points raised by the referee in the revised MS include:
Our study has a number of limitations such the lack of data on ethnicity, smoking habits, comorbidities, or medications: this is now clearly stated in Patients and Methods. We believe that such a detailed, multifactorial analysis would surpass the confines of a preliminary Observational Report. Of note, the patient database is available for review for the interested reader (please follow link under Reference 14 to "data source").

The most common causes of reactive thrombocytosis are now briefly listed in the Introduction.

The statement between platelet count and depth of invasion has been toned down - the reference to significance has been eliminated.

As emphasized in the MS, our conclusions are preliminary and are based on a limited number of patients. It is our hope that our findings will be confirmed (or refuted) based on a much larger patient cohort.

The localization of the primary tumor (right-sided versus left-sided) seems to have no impact on the presence or absence of thrombocytosis: both groups had an incidence of ~7%. This is now clearly stated in Results.

References have been corrected.
Whereas we share some of the reservations of the referee, we would like to point out that this is an Observational Study and not a full report. We believe that despite the limitations of this study, this is an interesting observation with potential implications for patient management. That said, we wholeheartedly agree with the referee that "these results need to be confirmed in a much larger cohort of colorectal patients."

Changes done in response to points raised by the referee in the revised MS include:
Our study has a number of limitations such the lack of data on ethnicity, smoking habits, comorbidities, or medications: this is now clearly stated in Patients and Methods. We believe that such a detailed, multifactorial analysis would surpass the confines of a preliminary Observational Report. Of note, the patient database is available for review for the interested reader (please follow link under Reference 14 to "data source").

The most common causes of reactive thrombocytosis are now briefly listed in the Introduction.

The statement between platelet count and depth of invasion has been toned down - the reference to significance has been eliminated.

As emphasized in the MS, our conclusions are preliminary and are based on a limited number of patients. It is our hope that our findings will be confirmed (or refuted) based on a much larger patient cohort.

The localization of the primary tumor (right-sided versus left-sided) seems to have no impact on the presence or absence of thrombocytosis: both groups had an incidence of ~7%. This is now clearly stated in Results.

References have been corrected.
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Author Response 13 Oct 2014

Arpad Szallasi, Department of Pathology, Monmouth Medical Center, Long Branch, NJ, NJ 07740, USA

13 Oct 2014

Author Response
Whereas we share some of the reservations of the referee, we would like to point out that this is an Observational Study and not a full report. We believe that ... Continue reading
Whereas we share some of the reservations of the referee, we would like to point out that this is an Observational Study and not a full report. We believe that despite the limitations of this study, this is an interesting observation with potential implications for patient management. That said, we wholeheartedly agree with the referee that "these results need to be confirmed in a much larger cohort of colorectal patients."

Changes done in response to points raised by the referee in the revised MS include:
Our study has a number of limitations such the lack of data on ethnicity, smoking habits, comorbidities, or medications: this is now clearly stated in Patients and Methods. We believe that such a detailed, multifactorial analysis would surpass the confines of a preliminary Observational Report. Of note, the patient database is available for review for the interested reader (please follow link under Reference 14 to "data source").

The most common causes of reactive thrombocytosis are now briefly listed in the Introduction.

The statement between platelet count and depth of invasion has been toned down - the reference to significance has been eliminated.

As emphasized in the MS, our conclusions are preliminary and are based on a limited number of patients. It is our hope that our findings will be confirmed (or refuted) based on a much larger patient cohort.

The localization of the primary tumor (right-sided versus left-sided) seems to have no impact on the presence or absence of thrombocytosis: both groups had an incidence of ~7%. This is now clearly stated in Results.

References have been corrected.
Whereas we share some of the reservations of the referee, we would like to point out that this is an Observational Study and not a full report. We believe that despite the limitations of this study, this is an interesting observation with potential implications for patient management. That said, we wholeheartedly agree with the referee that "these results need to be confirmed in a much larger cohort of colorectal patients."

Changes done in response to points raised by the referee in the revised MS include:
Our study has a number of limitations such the lack of data on ethnicity, smoking habits, comorbidities, or medications: this is now clearly stated in Patients and Methods. We believe that such a detailed, multifactorial analysis would surpass the confines of a preliminary Observational Report. Of note, the patient database is available for review for the interested reader (please follow link under Reference 14 to "data source").

The most common causes of reactive thrombocytosis are now briefly listed in the Introduction.

The statement between platelet count and depth of invasion has been toned down - the reference to significance has been eliminated.

As emphasized in the MS, our conclusions are preliminary and are based on a limited number of patients. It is our hope that our findings will be confirmed (or refuted) based on a much larger patient cohort.

The localization of the primary tumor (right-sided versus left-sided) seems to have no impact on the presence or absence of thrombocytosis: both groups had an incidence of ~7%. This is now clearly stated in Results.

References have been corrected.
Competing Interests: None Close
Report a concern

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Reviewer Report 14 Aug 2014

Ioannis A. Voutsadakis, Medical Oncology, Sault Area Hospital, Ontario, Canada

Approved with Reservations

https://doi.org/10.5256/f1000research.5184.r5655

This is an interesting retrospective study of an extensive series of colorectal cancer patients and authors are to be congratulated on undertaking this academic endeavour. Nevertheless there are several points that need to be addressed. A major concern is that all stages of the disease have been included. In general a comparison between stage I and IV, for example, has no meaning clinically and the only statement that one can make is that thrombocytosis is more common. Another major concern is that no multivariate analysis is done or presented.

Some other specific points:

The title mentions specifically stage II disease (as the authors probably recognize the importance of prognostic factors in this sub-group for therapeutic decisions) but no statistical comparison is offered anywhere in the article. In any case the number of patients with thrombocytosis in this group (5) is prohibitive for definite conclusions.
In the last line of the Abstract and in the Discussion it should be: “treated as stage III” or even better “considered for adjuvant chemotherapy” (stage IV patients are treated with palliative intent).
Data on tumor grade and location have been collected (dataset) but not summarized or presented in the article. It would be of particular interest to present and include in an eventual multivariate analysis tumor location (right versus left from the splenic flexure versus rectal).
In Patients and methods the normal range of platelets in authors’ institution should be mentioned.
In the Results it would be interesting to provide the mean and SD of the platelet number in the 2 groups (normal and thrombocytosis).
In fig. 2 there is a discrepancy between HR and p values in the body and the legend. In addition the numbers at risk do not match. Is that a mistake in calculations or data missing? Authors should address this.
In the 4^th line of the 1^st paragraph of the Discussion” the reference does not seem to be correct. Same with reference 6 in the 2^ndparagraph.
In the discussion on metastatic patients - this is an over-simplification. If any useful comparison is to be made, other data have to be entered in the equation such as oligometastatic versus polymetastatic disease and treatments.
Treatments should be mentioned. For example have all stage III patients received adjuvant chemotherapy? And have any of the stage II patients received any such treatment?
In the 4^th paragraph of the Discussion the explanation of “false negative node examination” is improbable as there is no reason to suspect that such false negative occurs more commonly in patients with thrombocytosis. Instead a difference in biology as briefly discussed in the next paragraph is more probable.

Competing Interests: No competing interests were disclosed.

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Author Response 13 Oct 2014

Arpad Szallasi, Department of Pathology, Monmouth Medical Center, Long Branch, NJ, NJ 07740, USA

13 Oct 2014

Author Response
We are grateful for the referee for his thoughts in making this a better MS. Whereas we agree with most of the reservations of the referee, we would like to ... Continue reading
We are grateful for the referee for his thoughts in making this a better MS. Whereas we agree with most of the reservations of the referee, we would like to point out that this is an Observation Study, and not a full report. We believe that despite the limitations of our study, our conclusions are sound and (if confirmed) may have important implications for patient management.

Major changes done in response to points raised by the referee include:
We agree with the referee that the small number of patients (5) in the stage II group precludes a definitive conclusion; this is now clearly stated in the MS. Again, this is an Observational Study within the confines of our hospital database on colorectal carcinoma patients.

Both the Abstract and the Discussion have been modified as suggested by the referee ("treated as stage III" has been changed to "may be considered for adjuvant chemotherapy").

The multivariate analysis with special regard to the location of the tumor (right-sided versus left-sided) in now detailed in the Results.

The normal range of platelets at our Institution (150 to 400 K/ul) is now provided in the MS.

The mean +/-SD of the platelet counts in the two patient groups (with and without thrombocytosis) is now provided in Results.

Indeed, there is a discrepancy between the body of the text and Figure 2 with regard to the patient numbers; this should have been addressed before to avoid any confusion. As clearly stated now in Patients and Methods, our database included 310 patients. Of these patients, our Cancer Registry had long-term survival data on 253 patients (hence the discrepancy): the remaining 57 patients most likely decided to seek treatment at a different facility.

References have been corrected.

Discussion on metastatic patients has been modified.

Unfortunately, our Cancer Registry has no full details on chemotherapy regimens (some of our patients receive chemotherapy in a private practice setting).

The reference to "false negative node examination" has been eliminated.
We are grateful for the referee for his thoughts in making this a better MS. Whereas we agree with most of the reservations of the referee, we would like to point out that this is an Observation Study, and not a full report. We believe that despite the limitations of our study, our conclusions are sound and (if confirmed) may have important implications for patient management.

Major changes done in response to points raised by the referee include:
We agree with the referee that the small number of patients (5) in the stage II group precludes a definitive conclusion; this is now clearly stated in the MS. Again, this is an Observational Study within the confines of our hospital database on colorectal carcinoma patients.

Both the Abstract and the Discussion have been modified as suggested by the referee ("treated as stage III" has been changed to "may be considered for adjuvant chemotherapy").

The multivariate analysis with special regard to the location of the tumor (right-sided versus left-sided) in now detailed in the Results.

The normal range of platelets at our Institution (150 to 400 K/ul) is now provided in the MS.

The mean +/-SD of the platelet counts in the two patient groups (with and without thrombocytosis) is now provided in Results.

Indeed, there is a discrepancy between the body of the text and Figure 2 with regard to the patient numbers; this should have been addressed before to avoid any confusion. As clearly stated now in Patients and Methods, our database included 310 patients. Of these patients, our Cancer Registry had long-term survival data on 253 patients (hence the discrepancy): the remaining 57 patients most likely decided to seek treatment at a different facility.

References have been corrected.

Discussion on metastatic patients has been modified.

Unfortunately, our Cancer Registry has no full details on chemotherapy regimens (some of our patients receive chemotherapy in a private practice setting).

The reference to "false negative node examination" has been eliminated.
Competing Interests: None Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 13 Oct 2014

Arpad Szallasi, Department of Pathology, Monmouth Medical Center, Long Branch, NJ, NJ 07740, USA

13 Oct 2014

Author Response
We are grateful for the referee for his thoughts in making this a better MS. Whereas we agree with most of the reservations of the referee, we would like to ... Continue reading
We are grateful for the referee for his thoughts in making this a better MS. Whereas we agree with most of the reservations of the referee, we would like to point out that this is an Observation Study, and not a full report. We believe that despite the limitations of our study, our conclusions are sound and (if confirmed) may have important implications for patient management.

Major changes done in response to points raised by the referee include:
We agree with the referee that the small number of patients (5) in the stage II group precludes a definitive conclusion; this is now clearly stated in the MS. Again, this is an Observational Study within the confines of our hospital database on colorectal carcinoma patients.

Both the Abstract and the Discussion have been modified as suggested by the referee ("treated as stage III" has been changed to "may be considered for adjuvant chemotherapy").

The multivariate analysis with special regard to the location of the tumor (right-sided versus left-sided) in now detailed in the Results.

The normal range of platelets at our Institution (150 to 400 K/ul) is now provided in the MS.

The mean +/-SD of the platelet counts in the two patient groups (with and without thrombocytosis) is now provided in Results.

Indeed, there is a discrepancy between the body of the text and Figure 2 with regard to the patient numbers; this should have been addressed before to avoid any confusion. As clearly stated now in Patients and Methods, our database included 310 patients. Of these patients, our Cancer Registry had long-term survival data on 253 patients (hence the discrepancy): the remaining 57 patients most likely decided to seek treatment at a different facility.

References have been corrected.

Discussion on metastatic patients has been modified.

Unfortunately, our Cancer Registry has no full details on chemotherapy regimens (some of our patients receive chemotherapy in a private practice setting).

The reference to "false negative node examination" has been eliminated.
We are grateful for the referee for his thoughts in making this a better MS. Whereas we agree with most of the reservations of the referee, we would like to point out that this is an Observation Study, and not a full report. We believe that despite the limitations of our study, our conclusions are sound and (if confirmed) may have important implications for patient management.

Major changes done in response to points raised by the referee include:
We agree with the referee that the small number of patients (5) in the stage II group precludes a definitive conclusion; this is now clearly stated in the MS. Again, this is an Observational Study within the confines of our hospital database on colorectal carcinoma patients.

Both the Abstract and the Discussion have been modified as suggested by the referee ("treated as stage III" has been changed to "may be considered for adjuvant chemotherapy").

The multivariate analysis with special regard to the location of the tumor (right-sided versus left-sided) in now detailed in the Results.

The normal range of platelets at our Institution (150 to 400 K/ul) is now provided in the MS.

The mean +/-SD of the platelet counts in the two patient groups (with and without thrombocytosis) is now provided in Results.

Indeed, there is a discrepancy between the body of the text and Figure 2 with regard to the patient numbers; this should have been addressed before to avoid any confusion. As clearly stated now in Patients and Methods, our database included 310 patients. Of these patients, our Cancer Registry had long-term survival data on 253 patients (hence the discrepancy): the remaining 57 patients most likely decided to seek treatment at a different facility.

References have been corrected.

Discussion on metastatic patients has been modified.

Unfortunately, our Cancer Registry has no full details on chemotherapy regimens (some of our patients receive chemotherapy in a private practice setting).

The reference to "false negative node examination" has been eliminated.
Competing Interests: None Close
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Ioannis A. Voutsadakis, Sault Area Hospital, Ontario, Canada
Judit Moldvay, Semmelweis University, Budapest, Hungary

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10 Nov 2014 | for Version 2

Ioannis A. Voutsadakis, Medical Oncology, Sault Area Hospital, Ontario, Canada

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Approved

The report is now acceptable for indexing.

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27 Oct 2014 | for Version 2

Judit Moldvay, Department of Pulmonology, Semmelweis University, Budapest, Hungary

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Approved

The Authors have corrected the manuscript according to the referees’ comments and completions, therefore, this revised manuscript is acceptable for indexation.

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06 Oct 2014 | for Version 1

Judit Moldvay, Department of Pulmonology, Semmelweis University, Budapest, Hungary

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Approved With Reservations

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Author Response

13 Oct 2014

Arpad Szallasi, Department of Pathology, Monmouth Medical Center, Long Branch, NJ, NJ 07740, USA

Whereas we share some of the reservations of the referee, we would like to point out that this is an Observational Study and not a full report. We believe that despite the limitations of this study, this is an interesting observation with potential implications for patient management. That said, we wholeheartedly agree with the referee that "these results need to be confirmed in a much larger cohort of colorectal patients."

Changes done in response to points raised by the referee in the revised MS include:

Our study has a number of limitations such the lack of data on ethnicity, smoking habits, comorbidities, or medications: this is now clearly stated in Patients and Methods. We believe that such a detailed, multifactorial analysis would surpass the confines of a preliminary Observational Report. Of note, the patient database is available for review for the interested reader (please follow link under Reference 14 to "data source").
The most common causes of reactive thrombocytosis are now briefly listed in the Introduction.
The statement between platelet count and depth of invasion has been toned down - the reference to significance has been eliminated.
As emphasized in the MS, our conclusions are preliminary and are based on a limited number of patients. It is our hope that our findings will be confirmed (or refuted) based on a much larger patient cohort.
The localization of the primary tumor (right-sided versus left-sided) seems to have no impact on the presence or absence of thrombocytosis: both groups had an incidence of ~7%. This is now clearly stated in Results.
References have been corrected.

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Competing Interests

None

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14 Aug 2014 | for Version 1

Ioannis A. Voutsadakis, Medical Oncology, Sault Area Hospital, Ontario, Canada

14 Views Cite this report Responses(1)

Approved With Reservations

The title mentions specifically stage II disease (as the authors probably recognize the importance of prognostic factors in this sub-group for therapeutic decisions) but no statistical comparison is offered anywhere in the article. In any case the number of patients with thrombocytosis in this group (5) is prohibitive for definite conclusions.
In the last line of the Abstract and in the Discussion it should be: “treated as stage III” or even better “considered for adjuvant chemotherapy” (stage IV patients are treated with palliative intent).
Data on tumor grade and location have been collected (dataset) but not summarized or presented in the article. It would be of particular interest to present and include in an eventual multivariate analysis tumor location (right versus left from the splenic flexure versus rectal).
In Patients and methods the normal range of platelets in authors’ institution should be mentioned.
In the Results it would be interesting to provide the mean and SD of the platelet number in the 2 groups (normal and thrombocytosis).
In fig. 2 there is a discrepancy between HR and p values in the body and the legend. In addition the numbers at risk do not match. Is that a mistake in calculations or data missing? Authors should address this.
In the 4^th line of the 1^st paragraph of the Discussion” the reference does not seem to be correct. Same with reference 6 in the 2^ndparagraph.
In the discussion on metastatic patients - this is an over-simplification. If any useful comparison is to be made, other data have to be entered in the equation such as oligometastatic versus polymetastatic disease and treatments.
Treatments should be mentioned. For example have all stage III patients received adjuvant chemotherapy? And have any of the stage II patients received any such treatment?
In the 4^th paragraph of the Discussion the explanation of “false negative node examination” is improbable as there is no reason to suspect that such false negative occurs more commonly in patients with thrombocytosis. Instead a difference in biology as briefly discussed in the next paragraph is more probable.

Competing Interests

No competing interests were disclosed.

Respond to this report

Responses (1)

Author Response

13 Oct 2014

Arpad Szallasi, Department of Pathology, Monmouth Medical Center, Long Branch, NJ, NJ 07740, USA

We are grateful for the referee for his thoughts in making this a better MS. Whereas we agree with most of the reservations of the referee, we would like to point out that this is an Observation Study, and not a full report. We believe that despite the limitations of our study, our conclusions are sound and (if confirmed) may have important implications for patient management.

Major changes done in response to points raised by the referee include:

We agree with the referee that the small number of patients (5) in the stage II group precludes a definitive conclusion; this is now clearly stated in the MS. Again, this is an Observational Study within the confines of our hospital database on colorectal carcinoma patients.
Both the Abstract and the Discussion have been modified as suggested by the referee ("treated as stage III" has been changed to "may be considered for adjuvant chemotherapy").
The multivariate analysis with special regard to the location of the tumor (right-sided versus left-sided) in now detailed in the Results.
The normal range of platelets at our Institution (150 to 400 K/ul) is now provided in the MS.
The mean +/-SD of the platelet counts in the two patient groups (with and without thrombocytosis) is now provided in Results.
Indeed, there is a discrepancy between the body of the text and Figure 2 with regard to the patient numbers; this should have been addressed before to avoid any confusion. As clearly stated now in Patients and Methods, our database included 310 patients. Of these patients, our Cancer Registry had long-term survival data on 253 patients (hence the discrepancy): the remaining 57 patients most likely decided to seek treatment at a different facility.
References have been corrected.
Discussion on metastatic patients has been modified.
Unfortunately, our Cancer Registry has no full details on chemotherapy regimens (some of our patients receive chemotherapy in a private practice setting).
The reference to "false negative node examination" has been eliminated.

View more View less

Competing Interests

None

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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[1] 1. Michelson AD (ed): Platelets. Academic Press, Ebook. 2011. Reference Source

[2] 2. Lin RJ, Afshar-Khargan V, Schafer AI: Paraneoplastic thrombocytosis: the secrets of tumor self-promotion. Blood. 2014; 124(2): 184–187. PubMed Abstract | Publisher Full Text

[3] 3. Costatini V, Zacharski LR, Moritz TE, et al.: The platelet count in carcinoma of the lung and colon. Thromb Haemost. 1990; 64(4): 501–505. PubMed Abstract

[4] 4. Symbas NP, Townsend MF, El-Galley R, et al.: Poor prognosis associated with thrombocytosis in patients with renal cell carcinoma. BJU Int. 2000; 86(3): 203–207. PubMed Abstract | Publisher Full Text

[5] 5. Stone RL, Nick AM, McNeish IA, et al.: Paraneoplastic thrombocytosis in ovarian cancer. N Eng J Med. 2012; 366(7): 610–618. PubMed Abstract | Publisher Full Text | Free Full Text

[6] 6. Ikeda M, Furukawa H, Imamura H, et al.: Poor prognosis associated with thrombocytosis in patients with gastric cancer. Ann Surg Oncol. 2002; 9(3): 287–291. PubMed Abstract

[7] 7. McArdle CS, Hole DJ: Outcome following surgery for colorectal cancer. Br Med Bull. 2002; 64: 119–125. PubMed Abstract | Publisher Full Text

[8] 8. Sasaki K, Kawai K, Tsuno NH, et al.: Impact of preoperative thrombocytosis on the survival of patients with primary colorectal cancer. World J Surg. 2012; 36(1): 192–200. PubMed Abstract | Publisher Full Text

[9] 9. Kandemir EG, Mayadagli A, Karagoz B, et al.: Prognostic significance of thrombocytosis in node-negative colon cancer. J Int Med Res. 2005; 33(2): 228–235. PubMed Abstract | Publisher Full Text

[10] 10. Voutsadakis IA: Thrombocytosis as a prognostic marker in gastrointestinal cancers. World J Gastrointest Oncol. 2014; 6(2): 34–40. PubMed Abstract | Publisher Full Text | Free Full Text

[11] 11. Nyasavajjala SM, Runau F, Datta S, et al.: Is there a role for pre-operative thrombocytosis in the management of colorectal cancer? Int J Surg. 2010; 8(6): 436–438. PubMed Abstract | Publisher Full Text

[12] 12. Engstrom PF, Arnolett JP, Benson AB 3rd, et al.: NCCN Clinical Practice Guidelines for Oncology: colon cancer. J Natl Compr Canc Netw. 2009; 7(8): 778–831. PubMed Abstract

[13] 13. McCarty OJ, Mousa SA, Bray PF, et al.: Immobilized platelets support human colon carcinoma cell tethering, rolling, and firm adhesion under dynamic flow conditions. Blood. 2000; 96(5): 1789–1797. PubMed Abstract

[14] 14. Guo T, Krzystanek M, Szallasi Z, et al.: Data of thrombocytosis in colon cancer patients. F1000Research. 2014. Data Source

Thrombocytosis portends adverse prognostic significance in patients with stage II colorectal carcinoma

Abstract

Introduction

Patients and methods

Results

Table 1. Patient characteristics.

Table 2. Incidence of thrombocytosis in each stage of colorectal cancer.

Figure 1. Mean platelet count according to the depth of tumor invasion.

Figure 2. Overall survival plots of patients with stage I to stage III colorectal cancer according the preoperative platelet counts.

Discussion

Data availability

Author contributions

Competing interests

Grant information

References

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