Clinical Research Papers:

A relative increase in circulating platelets following chemoradiation predicts for poor survival of patients with glioblastoma

Keeratikarn Boonyawan _, Kenneth R. Hess, Jie Yang, Lihong Long, Qianghu Wang, Ravesanker Ezhilarasan, Alessandra Auia, Kristin D. Alfaro-Munoz, John F. de Groot, Krishna P. Bhat and Erik P. Sulman

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Oncotarget. 2017; 8:90488-90495. https://doi.org/10.18632/oncotarget.21799

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Keeratikarn Boonyawan1,3, Kenneth R. Hess2, Jie Yang3, Lihong Long3, Qianghu Wang3, Ravesanker Ezhilarasan3, Alessandra Auia4, Kristin D. Alfaro-Munoz5, John F. de Groot5, Krishna P. Bhat4 and Erik P. Sulman3

1 Department of Radiation Oncology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

2 Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

3 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

4 Department of Translational Molecular Pathology and Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

5 Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

Correspondence to:

Erik P. Sulman, email:

Keywords: glioblastoma, platelets, thrombocytosis, prognosis, survival

Received: June 05, 2017 Accepted: August 07, 2017 Published: October 12, 2017


Background: Thrombocytosis is triggered by and promotes tumor growth. The relationship between the change in circulating platelets after chemoradiation therapy (CRT) or adjuvant temozolomide (TMZ) and survival in glioblastoma remains unclear. We hypothesized that an increase in platelets after these treatments would be predictive of a shorter survival.

Methods: We retrospectively reviewed data on 122 patients with newly diagnosed, pathologically proven glioblastoma who had been treated with surgery, followed by CRT and adjuvant TMZ, from 2007 to 2016. The association between the changes in blood count levels and survival was analyzed by the log-rank test. To adjust for confounding, we performed a multivariate analysis using known prognostic co-variates.

Results: Patients were dichotomized on the basis of the relative change in platelets after CRT from the baseline: ≤30% increase, low (n = 101) vs >30% increase, high (n = 12). The median survival for high vs. low platelets were 11 vs 28 months (p = 0.0062). No significant survival differences were observed on the basis of platelet changes during adjuvant TMZ. Similarly, changes in lymphocyte counts were not significantly prognostic. On multivariate analysis, MGMT, performance status, and an increase in platelets after CRT were significantly associated with survival (HR for platelets, 4.5; 95% confidence interval, 1.6-12.6).

Conclusions: Increased platelet counts after CRT are predictive of poor survival in glioblastoma. The effect is platelet specific and does not reflect bone marrow changes, as lymphocyte changes were not significantly prognostic. These results suggest an interaction between platelets and tumor aggressiveness. Thus, platelets serve as a novel, minimally invasive liquid biopsy for predicting outcome.

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