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Folia Medica 2011; 46 No 1:28-34Table 6. Analysis of the mean platelet* count of patients with NSCLS according to the TNM classification (IIAand IIB in relation IIIA, IIIB and IV)TNMCLASSIFICATIONPatients with NSCLC(IIA, IIB)Patients with NSCLC(IIIA, IIIB i IV)XminXmaxaverageX95 % CIstandarddeviation(+/-)median207 601 374 331-415 108 350134 811 408 389-426 120 408likelysignificancep>0.05r.n.sLEGEND: platelet* = platelet count x 10 9 /LTable 7. Analysis of mean values of platelet* counts in patients with NSCLS and SCLSPatients Xmin XmaxPatients withNSCLCPatients withSCLCaverageX95 % CIstandarddeviation(+/-)median134 811 377 360-393 112 390134 793 324 228-360 143 282likelysignificancep>0.05r.n.s*LEGEND: platelet* = platelet count x 10 9 /Lstatistically significant differences in meanvalues of platelets count between two testedgroups at the significance level p>0.05.Statistical analysis of mean values ofplatelets count NSCLC compared to SCLCis shown on Table 7. There was no significantdifference at the significance level p>0.05.DiscussionOne of the most common blood abnormalitiesof patients with solid tumors is thrombocytosis(2-4,5-8,13). Several studies haveconfirmed thrombocytosis as paraneoplasticsymptom (2-6,8-12).In a certain percentage, reactive thrombocytosiswas observed, in the diagnosis oflung cancer, prior chemotherapy and/or surgery(2-4).Pathogenesis of reactive thrombocytosisassociated with malignancy has not yet beencompletely solved. The precise mechanismof reactive thrombocytosis may be due tomediators secreted by tumor cells, whichdirectly affect production bone marrowmegakaryocytes. Mediators of tumor cells,such as IL-6, IL-1, IL-11 and macrophagecolony-stimulating factor (14) are probablyresponsible for the thrombocytosis asparaneoplastic symptom (13,15). In addition,some tumors, such as ovarian cancer(15,16), hepatoblastoma and hepatocellularcancer produce thrombopoietin, which hasthe effect on thrombocytosis (7,17).Recent studies indicate interaction betweentumor cells, endothelial cells andplatelets which contribute to the developmentof metastases and poor prognosis onsurvival (13,18,19,20). However, the prognosticsignificance of thrombocytosis onsurvival time has not yet been elucidated.Platelets help tumor spread by increasingthe adhesion of tumor cells in the endotheliumof blood vessels and accumulating inthe tumor cells. In this way, at the same time,platelets prevent the detection and removalof tumor cells by the immune system (21).The largest number of patients with lungcancer in our study was from 51 to 60 yearsof age (No=92, or 38.5%). Number of men32
Arslanagić S et al.: Diagnostic Significance of Platelet Count in Patients With Lung Cancer(No. = 183, or 76.6%) was three times greaterthan the number of women (No = 56, or23.4%). Ratio of men to women was 3.2:1.Pedersen LM and Milman N (3), like GarciaPrim JM et al. (21), had similar gender ratio.About 43.8% ofNSCLC was adenocancer,37.2% squamous cell cancer and 1.5%large cell lung cancer. Similar results havebeen reported in study Pedersen LM. andMilman N. (3.5), Garcia Prim JM et al. (22)and Moyer P (23).In our study, from the 42 patients sufferingfrom SCLC, 20 patients (45.0%) were inlimited stage according to TNM classification,and 22 patients (55.0%) in the expandedstage. We found that SCLC men fourtimes more than women. Pedersen LM andMilman N (3,5), Garcia Prim JM et al. (22)and Moyer P (23) have found similar results.The mean platelets value of lung cancerpatients in our study was 395x10 9 /l, standarddeviation of 122.0. The lowest plateletsvalues was 134x10 9 /l. The largest number ofplatelets was 811x10 9 /l.Different authors found different resultsof thrombocytosis in lung cancer patientsas results a different time when authors determinednumber of platelets. Aoe K et al.(2) determined the number of platelets atthe first hospital admission. The prevalenceof thrombocytosis at that time was lower,about 16%. Survival time of lung cancer patientswith thrombocytosis was 7.5 monthsand was significantly lower to 10.1 monthsto lung cancer patients without thrombocytosis.Statistical analysis of mean platelets valuesof specific histopathological types ofcancer (adenocancer, squamous cell cancer,large cell cancer and small cell lung cancer)to the control group, for each type of cancer,were statistically significant difference.On the basis of our research , we can concludethat thrombocytosis was more presentin advanced TNM stages lung cancer , butnot significantly, compared to less advancedstages of lung cancer. Results supporting ourfindings have been reported in study Aoe Ket al (2), Pedersen LM and Milman (3,5),Engan T, Hannisdal E (11), Gislason T et al.(24).Unlike these results, Inoue K et al. (25)found a positive association of thrombocytosisas tumor size as like TNM stage of renalcell cancer. The same authors not foundpositive correlation between thrombocytosisand histological type of cancer. They alsofound that the number of platelets, after renalcell cancer nephrectomy, normalized inall patients with thrombocytosis.We must emphasize that there is verylittle data in the literature examined thepresence of thrombocytosis in certain histopathologicaltypes of lung cancer.There were no significant difference betweenmean values of platelets count NSCLCand SCLC in our research. Pedersen LM andMilman N (5) found significantly higherthrombocytosis in patients with SCLC inrelation to thrombocytosis in patients withNSCLC. The same authors attach great importanceon present thrombocytosis in patientswith lung cancer. They concluded thatthe tumors markers cannot provide moreinformation about the malignant nature ofsome changes in relation to the increasednumber of platelets.ConclusionThere are significant differences in meanvalues of platelets count among lung cancerpatients in relation to the control group.We did not found a statistically significantdifference between mean values of plateletscount in NSCLC in relation to SCLC.We haven’t found a significant differencein the variability of the mean values of plateletscount between different TNM stages oflung cancer.33
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