Abstract Number: LPB0141
Meeting: ISTH 2021 Congress
Theme: Women Health » Estrogens and Progestinics
Background: Ex-vivo activation of platelet was reported in women with breast cancer (BC). Mixed evidence from literature exists that mean platelet volume (MPV) is higher in cancer vs benign breast tumors and maybe associated with larger tumors, higher stage and poorer prognosis. Predictive markers are required to identify high-risk patients who may develop metastasis.
Aims: To systematically evaluate platelet activation and platelet volume indices in women with BC in chemo-naïve locally invasive and metastatic disease.
Methods: Patients were recruited from oncology center at our local hospital between 2019 to 2020 following ethics approval. Patient groups included: 80 locally invasive BC patients (stages I,II,III), 20 metastatic (stage IV) and 100 age-matched controls. Platelet activation in response to ADP was assessed by light-transmission aggregometry. Platelet P-selectin (CD62P) expression with and without ADP stimulation was assessed by flowcytometry. Comprehensive analysis of platelet count and all platelet volume indices (PVIs) (MPV, PDW, MPV/P and PDW/P). Data were analyzed in relation to tumor pathology, hormone receptors (ER, PR, HER-2) and proliferation index Ki-67. Regression analyses were conducted for prediction of poor prognosis, tumor aggression and metastatic potential.
Results: There was significant increase in platelet aggregation (MA), CD62P expression, CD62P+ADP, MPV, PDW, MPV/P and PDW/P in the metastatic group compared to the locally invasive group (Table1). Tumor size and grade were significantly correlated with ADP-MA, CD62P, CD62P+ADP, MPV, PDW, MPV/P and PDW/P. The area under curve showed (0.98, 0.9, 0.97, 0.93, 0.66, 0.7, 0.8, 0.73) for ADP MA, CD-62, CD-62P+ADP, CD-62P Diff., MPV, PDW, MPV/P, PDW/P) respectively. Univariate regression analysis showed significance for MA, CD62P, CD62P+ADP, CD-62P Diff., PLTs count, MPV, PDW, MPV/P, PDW/P (Table2).
| Parameters / Groups | Control group | Locally invasive BC group | Metastatic BC group | P value |
| Platelets 109/L Mean ±SD | 234 ± 43 | 11.8 ± 1.6 | 10.5 ± 1.4 | ≤0.001 |
| MPV fL Mean ±SD | 10.9 ± 0.9 | 14.6 ± 1.5 | 16.7 ± 1.1 | 0.02 |
| PDW fL Mean ±SD | 13.9 ± 2.17 | 16.1 ± 3.9 | 18.4 ± 5.2 | 0.044 |
| MPV/P fL/109/L Mean ±SD | 0.048 ± 0.01 | 1.3 ± 0.25 | 1.6 ± 0.16 | ≤0.001 |
| PDW/P fL/109/L Mean ±SD | 0.067 ± 0.01 | 1.43 ± 0.03 | 1.77 ± 0.2 | 0.044 |
| APD MA % Mean ±SD | 54.7 ± 12.1 | 73.7 ± 19 | 115 ± 5 | ≤0.001 |
| CD-62P % Mean ±SD | 2.7 ± 1.3 | 3.5 ± 1.4 | 6.9 ± 1.9 | 0.02 |
| CD-62P + ADP % Mean ±SD | 23.4 ± 10 | 46.8 ± 17.7 | 81.5 ± 5 | ≤0.001 |
| CD-62P Diff. Mean ±SD | 20.5 ± 10 | 43.5 ± 18.5 | 74.5 ± 5.5 | 0.001 |
Comparison between control group and BC patient group in relation to platelet volume indices (PVIs), aggregation and flowcytometry work-up. MPV: mean platelet volume, PDW: platelet distribution width, MPV/P: MPV divided by platelet count. ADP-MA: maximum platelet aggregation with ADP, CD-62P and CD-62P+ADP: P-selectin expression at basal level and with ADP. CD-62P Diff: difference between basal and activated CD-62P.
| Parameters | P value | OR | Lower 95% CI | Higher 95% CI |
| APD MA | <0.001 | 1.29 | 1.127 | 1.479 |
| CD-62P | 0.022 | 2.027 | 1.5 | 2.7 |
| CD-62P + ADP | 0.001 | 1.3 | 1.126 | 1.502 |
| CD-62P Diff. | 0.01 | 1.205 | 1.097 | 1.324 |
| Platelets | 0.002 | 0.56 | 0.386 | 0.812 |
| MPV | 0.044 | 1.409 | 0.995 | 1.996 |
| PDW | 0.011 | 0.978 | 0.967 | 0.989 |
| MPV/P | 0.03 | 143.5 | 9.8 | 210.1 |
| PDW/P | 0.003 | 0.04 | 0.01 | 0.095 |
Univariate regression analysis for prediction of tumor aggression and metastatic potential of BC. OR: odds ratio, CI: confidence interval, MPV: mean platelet volume, PDW: platelet distribution width, MPV/P: MPV divided by platelet count. ADP-MA: maximum platelet aggregation with ADP, CD-62P and CD-62P+ADP: P-selectin expression at basal level and with ADP. CD-62P Diff: difference between basal and activated CD-62P.
Conclusions: PVIs (MPV/P and PDW/P) can be used as simple, easily available and low cost predictors for cancer progression and poor prognosis. Also, MA and CD62P+ADP can be regarded significant predictors for metastatic BC.
To cite this abstract in AMA style:
Tera Y, Azzam H, Abousamra N, Zaki M, Eltantawy A, Awad M, Ghoneim H, Othman M. Platelet Activation and Platelet Indices as Markers for Disease Progression in Women with Breast Cancer [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/platelet-activation-and-platelet-indices-as-markers-for-disease-progression-in-women-with-breast-cancer/. Accessed November 29, 2021.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/platelet-activation-and-platelet-indices-as-markers-for-disease-progression-in-women-with-breast-cancer/