title: Prognostic value of pretherapy platelet elevation in oropharyngeal cancer patients treated with chemoradiation.
abstract: The purpose of this study is to evaluate potential associations between increased platelets and oncologic outcomes in oropharyngeal cancer patients receiving concurrent chemoradiation. A total of 433 oropharyngeal cancer patients (OPC) treated with intensity-modulated radiation therapy (IMRT) with concurrent chemotherapy between 2002 and 2012 were included under an approved IRB protocol. Complete blood count (CBC) data were extracted. Platelet and hemoglobin from the last phlebotomy (PLTpre-chemoRT, Hgbpre-chemoRT ) before start of treatment were identified. Patients were risk-stratified using Dahlstrom-Sturgis criteria and were tested for association with survival and disease-control outcomes. Locoregional control (LRC), freedom from distant metastasis (FDM) and overall survival (OS) were decreased (p < 0.03, p < 0.04 and p < 0.0001, respectively) for patients with PLTpre-chemoRT value of ≥350 × 10(9) /L. Actuarial 5-year locoregional control (LRC) and FDM were 83 and 85% for non-thrombocythemic patients while patient with high platelets had 5-year LRC and FDM of 73 and 74%, respectively. Likewise, 5-year OS was better for patients with normal platelet counts by comparison (76 vs. 57%; p < 0.0001). Comparison of univariate parametric models demonstrated that PLTpre-chemoRT was better among tested models. Multivariate assessment demonstrated improved performance of models which included pretherapy platelet indices. On Bayesian information criteria analysis, the optimal prognostic model was then used to develop nomograms predicting 3-, 5- and 10-year OS. In conclusion, pretreatment platelet elevation is a promising predictor of prognosis, and further work should be done to elucidate the utility of antiplatelets in modifying risk in OPC patients.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.|The University of Texas Medical School, Houston, TX.
authors.forename: Sara
authors.initials: S
authors.lastname: Shoultz-Henley
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Garden
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.|Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
authors.forename: Abdallah S R
authors.initials: AS
authors.lastname: Mohamed
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Tommy
authors.initials: T
authors.lastname: Sheu
authors.affiliation: Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Kroll
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: G Brandon
authors.initials: GB
authors.lastname: Gunn
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.|School of Public Health, University of North Texas Health Science Center, Denton, TX.
authors.forename: Amos J
authors.initials: AJ
authors.lastname: Hayes
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.|The University of Texas Medical School, Houston, TX.
authors.forename: Chloe
authors.initials: C
authors.lastname: French
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.|The University of Texas Medical School, Houston, TX.
authors.forename: Hillary
authors.initials: H
authors.lastname: Eichelberger
authors.affiliation: Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Division of Health Sciences & Technology, Massachusetts Institute of Technology, Charlestown, MA.
authors.forename: Jayashree
authors.initials: J
authors.lastname: Kalpathy-Cramer
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.|The University of Texas Medical School, Houston, TX.
authors.forename: Blaine D
authors.initials: BD
authors.lastname: Smith
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Jack
authors.initials: J
authors.lastname: Phan
authors.affiliation: Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Zeina
authors.initials: Z
authors.lastname: Ayoub
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Stephen Y
authors.initials: SY
authors.lastname: Lai
authors.affiliation: Rosalind Franklin University of Medicine and Science, Chicago, IL.
authors.forename: Brian
authors.initials: B
authors.lastname: Pham
authors.affiliation: Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Merrill
authors.initials: M
authors.lastname: Kies
authors.affiliation: Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Gold
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Erich
authors.initials: E
authors.lastname: Sturgis
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.|The University of Texas Graduate School of Biomedical Sciences, Houston, TX.
authors.forename: Clifton D
authors.initials: CD
authors.lastname: Fuller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000097:blood / Q000401:mortality / Q000628:therapy*; D010976:Platelet Count; D011379:Prognosis; D050397:Radiotherapy, Intensity-Modulated
keywords: chemoradiation; oropharyngeal cancer; platelet; prognosis; survival