Prognostic value of thrombocytosis in nasopharyngeal carcinoma in the era of intensity-modulated radiotherapy.
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INTRODUCTION: Thrombocytosis, recognized as a clinically significant event, has been established as an unfavorable prognostic factor in various solid tumors. This study aimed to investigate the prognostic value of thrombocytosis-occurring either before or during treatment-in patients with non-metastatic nasopharyngeal carcinoma (NPC) who received intensity-modulated radiotherapy (IMRT). METHODS: A total of 203 patients with NPC who received IMRT were retrospectively analyzed. Thrombocytosis was defined as a platelet count exceeding 300 × 10⁹/L. The prognostic significance of thrombocytosis was assessed using the log-rank test and multivariate analyses. RESULTS: Among the 203 patients, 42 cases (20.7%) exhibited thrombocytosis prior to treatment initiation, and 81 cases (39.9%) developed thrombocytosis during therapy. Patients with thrombocytosis had more advanced N stage compared to those without (48.8% vs. 30.0%; P = 0.008). The 5-year progression-free survival (PFS) rate was significantly lower in patients with thrombocytosis than in those without (78.3% vs. 89.1%; P = 0.019). Multivariate analyses revealed that thrombocytosis was an independent prognostic factor for inferior PFS (hazard ratio [HR] = 2.37, 95% confidence interval [CI] = 1.08-5.21; P = 0.032). A similar result was observed in the subgroup of patients who received induction chemotherapy with the TP regimen (HR = 2.88, 95% CI = 1.12-7.36; P = 0.028). CONCLUSIONS: Thrombocytosis occurring before or during treatment serves as a valuable predictor of disease progression and poor prognosis in patients with NPC. Patients presenting with thrombocytosis may require more intensive therapeutic strategies; therefore, the presence of thrombocytosis should be considered when selecting an induction chemotherapy regimen. Further prospective studies are warranted to confirm these findings.