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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Tumor-infiltrating platelets predict postoperative recurrence and survival in resectable pancreatic neuroendocrine tumor
Shuai-Shuai Xu, Hua-Xiang Xu, Wen-Quan Wang, Shuo Li, Hao Li, Tian-Jiao Li, Wu-Hu Zhang, Liang Liu, Xian-Jun Yu
Shuai-Shuai Xu, Hua-Xiang Xu, Wen-Quan Wang, Shuo Li, Hao Li, Tian-Jiao Li, Wu-Hu Zhang, Liang Liu, Xian-Jun Yu, Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 20032, China
Shuai-Shuai Xu, Hua-Xiang Xu, Wen-Quan Wang, Shuo Li, Hao Li, Tian-Jiao Li, Wu-Hu Zhang, Liang Liu, Xian-Jun Yu, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
Shuai-Shuai Xu, Hua-Xiang Xu, Wen-Quan Wang, Shuo Li, Hao Li, Tian-Jiao Li, Wu-Hu Zhang, Liang Liu, Xian-Jun Yu, Shanghai Pancreatic Cancer Institute, Shanghai 200032, China
Shuai-Shuai Xu, Hua-Xiang Xu, Wen-Quan Wang, Shuo Li, Hao Li, Tian-Jiao Li, Wu-Hu Zhang, Liang Liu, Xian-Jun Yu, Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China
Author contributions: Xu SS, Wang WQ, and Li S contributed equally to this work, in conducting clinical observations, analyzing the data, and writing the manuscript; Xu SS, Xu HX, Wang WQ, Li S, Li H, Li TJ, and Zhang WH performed the research; Xu HX, Liu L, and Yu XJ contributed equally to this work, in designing the research, revising the manuscript, and providing valuable suggestions for this study.
Supported by grants from the National Science Foundation for Distinguished Young Scholars of China, No. 81625016; the National Natural Science Foundation of China, No. 81871941, No. 81872366, No. 81827807, No. 81802675, and No. 81702341; the Outstanding Academic Leader Program of the “ Technological Innovation Action Plan” in Shanghai Science and Technology Commission, No. 18XD1401200; and the Young Talented Specialist Training Program of Shanghai.
Institutional review board statement: This study was reviewed and approved by the Human Research Ethics Committee of Fudan University Shanghai Cancer Center.
Informed consent statement: Written informed consent has been acquired from each patient.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Liang Liu, MD, PhD, Professor, Surgeon, Surgical Oncologist, Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai 200032, China. liuliang@fudanpci.org
Telephone: +86-21-64031446 Fax: +86-21-64031446
Received: May 22, 2019
Peer-review started: May 22, 2019
First decision: June 16, 2019
Revised: July 8, 2019
Accepted: July 19, 2019
Article in press: June 16, 2019
Published online: November 7, 2019
BACKGROUND
Platelets have been reported to participate in tumor cell growth, extravasation, epithelial–mesenchymal transition, metastasis, and drug resistance. However, the importance of platelets in pancreatic neuroendocrine tumor (pNET) lacks adequate literature support. The predictive value of tumor-infiltrating platelets (TIPs) in pNET remains unclear.
AIM
To investigate the relationship between TIPs and the prognosis of patients with pNET following radical resection.
METHODS
In total, 113 patients who had undergone radical surgical resection with a pathologic diagnosis of pNET were enrolled in this study. Immunohistochemical analysis of cluster of differentiation 42b (CD42b) expression in the tumor specimens was performed to determine the presence of TIPs. Univariate and multivariate analyses were used to analyze the prognostic value of TIPs.
RESULTS
TIPs were observed in intratumoral areas in 54 patients. Neither basic characteristics nor preoperative platelet-associated indicators showed a significant relationship with the presence of TIPs (all P > 0.05). Patients with positive intratumoral CD42b expression had worse overall survival (P = 0.005) and recurrence-free survival (P < 0.001) than those with negative intratumoral CD42b expression. Multivariate analysis demonstrated that TIPs were independent prognostic factors for overall survival (P = 0.049) and recurrence-free survival (P = 0.003). Nevertheless, platelet count, mean platelet volume, and platelet-to-lymphocyte ratio were not associated with postoperative survival or recurrence in pNET patients (all P > 0.05).
CONCLUSION
TIPs are a useful prognostic biomarker for patients with resectable pNET, and their detection represents a promising tool for pNET treatment strategy decisions.
Core tip: We uncovered the importance of platelets in pancreatic neuroendocrine tumors and investigated the association between clinical outcome and preoperative platelet-associated indicators and tumor-infiltrating platelets in pancreatic neuroendocrine tumors. Platelet count, mean platelet volume, and platelet-to-lymphocyte ratio determined by preoperative blood tests were not related to overall survival or recurrence-free survival. Thus, tumor-infiltrating platelets are potential independent indicators of survival and recurrence in patients with resectable pancreatic neuroendocrine tumors.
