title: Thresholds and timing of pre-operative thrombocytosis and ovarian cancer survival: analysis of laboratory measures from electronic medical records.
abstract: Thrombocytosis has been associated with poor ovarian cancer prognosis. However, comparisons of thresholds to define thrombocytosis and evaluation of relevant timing of platelet measurement has not been previously conducted.
  
  
  
  We selected Tumor Registry confirmed ovarian, primary peritoneal, and fallopian tube cancer cases diagnosed between 1995-2013 from the Vanderbilt University Medical Center. Laboratory measured platelet values from electronic medical records (EMR) were used to determine thrombocytosis at three thresholds: a platelet count greater than 350, 400, or 450 × 10(9)/liter. Timing was evaluated with 5 intervals: on the date of diagnosis, and up to 1, 2, 4, and 8 weeks prior to the date of diagnosis. Cox regression was used to calculate hazard ratios (HR) and confidence intervals (CI) for association with overall survival; adjustment included age, stage, grade, and histologic subtype of disease.
  
  
  
  Pre-diagnosis platelet measures were available for 136, 241, 280, 297, and 304 cases in the five intervals. The prevalence of thrombocytosis decreased with increasing thresholds and was generally consistent across the five time intervals, ranging from 44.8-53.2 %, 31.6-39.4 %, and 19.9-26.1 % across the three thresholds. Associations with higher grade and stage of disease gained significance as the threshold increased. With the exception of the lowest threshold on the date of diagnosis (HR350: 1.55, 95 % CI: 0.97-2.47), all other survival associations were significant, with the highest reaching twice the risk of death for thrombocytosis on the date of diagnosis (HR400: 2.01, 95 % CI: 1.25-3.23).
  
  
  
  Our EMR approach yielded associations comparable to published findings from medical record abstraction approaches. In addition, our results indicate that lower thrombocytosis thresholds and platelet measures up to 8 weeks before diagnosis may inform ovarian cancer characteristics and prognosis.
authors: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, 838-A, Nashville, TN, 37203, USA.
authors: Gabriella D
authors: GD
authors: Cozzi
authors: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, 838-A, Nashville, TN, 37203, USA.
authors: Jacob M
authors: JM
authors: Samuel
authors: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, 838-A, Nashville, TN, 37203, USA.
authors: Jason T
authors: JT
authors: Fromal
authors: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, 838-A, Nashville, TN, 37203, USA.
authors: Spencer
authors: S
authors: Keene
authors: Division of Gynecologic Oncology, Department of Obstetics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, 37203, USA.|Vanderbilt-Ingram Cancer Center, Nashville, TN, 37203, USA.
authors: Marta A
authors: MA
authors: Crispens
authors: Division of Gynecologic Oncology, Department of Obstetics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, 37203, USA.|Vanderbilt-Ingram Cancer Center, Nashville, TN, 37203, USA.
authors: Dineo
authors: D
authors: Khabele
authors: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, 838-A, Nashville, TN, 37203, USA. alicia.beeghly@vanderbilt.edu.|Vanderbilt-Ingram Cancer Center, Nashville, TN, 37203, USA. alicia.beeghly@vanderbilt.edu.
authors: Alicia
authors: 0000-0001-9913-732X
authors: A
authors: Beeghly-Fadiel
mesh_terms: D000368:Aged; D057286:Electronic Health Records; D005185:Fallopian Tube Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D010976:Platelet Count; D057234:Preoperative Period; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D013922:Thrombocytosis / Q000175:diagnosis* / Q000401:mortality
keywords: Electronic medical records; Ovarian cancer; Platelets; Survival; Thrombocytosis