ABNORMAL HAEMATOLOGICAL PARAMETERS IN EC 173 7 prognostic relevance, however, still remains conflicting in EC studies, probably due to different used cut-off values for thrombocytosis.13, 14, 18 Comparable to our study, Njolstad et al. (2013) found a significant reduced DSS of patients with thrombocytosis.16 However, thrombocytosis as dichotomous value instead of continuous platelet count was not found as independent factor for DSS and RFS.13 The pathophysiological mechanism between tumour behaviour and preoperative thrombocytosis is not fully elucidated.18 The overexpression of inflammatory cytokines results in an increase of megakaryocyte maturation which causes increased platelet production.33 Some hypothesize that platelets infiltrate tumour tissue and contribute to tumour growth by secreting pro-angiogenic factors and pro-tumorigenic factors, while others suggest a platelet-cancer interaction facilitating cancer cell migration, which contributes cancer metastasis.34 The impact of leucocytosis on tumour behaviour may also be explained by upregulation of inflammatory cytokines and hematopoietic growth factor through tumour cells, thus promoting enhanced inflammation, leucocytosis, angiogenesis and tumour cell proliferation.11, 35 We observed a significant association between leucocytosis and the ESGO/ESTRO/ESP advanced/metastatic risk group in our study cohort, however leucocytosis was not significant in univariable and multivariable analysis. A recent meta-analysis found a correlation between leucocytosis and FIGO advanced-stage20, of whom only one study performed a multivariable analysis for RFS with comparable results as our study.19 Due to the pro-angiogenic factors induced with elevated platelet and leukocyte count, its suspected that angiogenesis will lead to a better drug or oxygen access to tumour cells, however there is a lack of homogeneity of vasculature density in different parts of the same tumour which could affect outcome and response to adjuvant treatment.9 Although we did not observe impact of thrombocytosis and/or leucocytosis on response to RT, included numbers were low. In patients with cervical cancer leucocytosis was related to poor response to RT, but due to differences in carcinogenesis it may be difficult to compare those results with EC.10 As shown in this study, some patients are diagnosed with EC during their reproductive years. So far, haematological parameters in solely young women with EC has not been studied. It might be relevant in future studies to evaluate whether these haematological biomarkers could additionally assist in fertility-sparing strategies (including hormonal, surgical and assisted reproductive technologies) in young women with EC. For hormonal treatment, progestin is recommended as first-line therapy based on the antiproliferative effect of the endometrium. Using hormones in stage IA EEC until completion of childbearing has not been associated with decreased oncologic outcomes compare to women who underwent hysterectomy (97.5% 5-year overall survival).2, 4
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