title: Increased platelet counts after transthoracic en bloc resection for esophageal cancer is associated with significantly improved survival.
abstract: BACKGROUND
  We analyzed perioperative platelet counts as a potential clinical marker for survival after transthoracic en bloc resection for esophageal cancer. Recent data described preoperative thrombocytosis in malignancies to be associated with poor prognosis.
  
  
  METHODS
  A retrospective analysis from a prospective database (1997-2006) was performed for 291 consecutive patients with esophageal cancer who underwent transthoracic en bloc esophagectomy and extended lymphadenectomy. Squamous cell cancer was found in 47.0% and adenocarcinoma in 50.9% (2.1% had rare histologies). Neoadjuvant chemoradiation was performed in 152 (52%) patients. Platelet counts before surgery and on postoperative days (PODs) 1, 10, and 30 were evaluated. We used the published cutoff value of 293 × 10(9)/l (mean of 80 healthy controls ± standard deviation) for platelet counts.
  
  
  RESULTS
  High platelet counts before surgery missed significance for poorer survival (p = 0.054). Following a perioperative fall in thrombocytes, a significant rise at POD 10 after surgery was evident. Platelet counts of more than 293 × 10(9)/l at this time correlated with a significantly improved survival rate (p = 0.027). Patients with no increase in thrombocytes until POD 10 had significantly poorer survival (p = 0.012). Multivariate analysis confirmed that a thrombocyte increase between the preoperative count and that on POD 10 is an independent prognostic indicator (p = 0.035) for patients with completely (R0) resected tumors.
  
  
  CONCLUSIONS
  An increase in platelet counts measured on POD 10 following transthoracic en bloc esophagectomy and extended lymphadenectomy is an independent prognostic indicator for improved survival in patients with esophageal cancer.
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Straße 62, Cologne, 50937, Germany.
authors.forename: Frederike C
authors.initials: FC
authors.lastname: Ling
authors.forename: Daniel
authors.initials: D
authors.lastname: Vallböhmer
authors.forename: Arnulf H
authors.initials: AH
authors.lastname: Hoelscher
authors.forename: Daniel
authors.initials: D
authors.lastname: Schmidt
authors.forename: Elfriede
authors.initials: E
authors.lastname: Bollschweiler
authors.forename: Paul M
authors.initials: PM
authors.lastname: Schneider
mesh_terms: D000230:Adenocarcinoma / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000503:physiopathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D013922:Thrombocytosis / Q000503:physiopathology*; D055815:Young Adult