Thrombocytosis helps to stratify risk of colorectal cancer in patients referred on a 2-week-wait pathway
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SHORT COMMUNICATION
Thrombocytosis helps to stratify risk of colorectal cancer in patients referred on a 2-week-wait pathway J. A. Bailey 1
&
N. Hanbali 1 & K. Premji 2 & J. Bunce 1 & S. Mashlab 1 & J. A. Simpson 1 & D. J. Humes 1,3 & A. Banerjea 1
Accepted: 13 April 2020 # The Author(s) 2020
Abstract Purpose Primary care studies suggest that thrombocytosis (platelet counts > 400 × 109/L) is associated with an increased risk of colorectal cancer (CRC). We aimed to establish whether this marker has significant stratification value in patients seen in secondary care. Methods A retrospective review of 2991 patients referred to our colorectal 2-week-wait (2WW) pathway between August 2014 and August 2017. Patient demographics were recorded prospectively, and local electronic records systems were used to retrieve full blood counts (FBC) and cancer diagnoses. Patients with no recent platelet count at the time of referral or incomplete records were excluded. Results 2236 patients were included in this evaluation. There was no significant difference in the age distribution of those with thrombocytosis and those without. There were significantly more females in the thrombocytosis group (72.1% vs 53.9%, chisquared 24.63, p < 0.0001). 130 CRCs were detected (5.8%) and patients with thrombocytosis were more likely to have CRC (OR 2.62, 95% CI 1.60–4.30). The CRC diagnosis rate was significantly higher in females with thrombocytosis (10.3% vs 2.9%, chi-squared 19.41, p < 0.0001) and males with thrombocytosis (16.1% vs 7.9%, chi-squared 4.62, p = 0.032). Conclusion Thrombocytosis appears to have stratification value in the 2WW population. Further evaluation of its value alone or in combination with other stratification tests is required. Keywords Colorectal cancer . Thrombocytosis . Two-week-wait stratification . Risk stratification
Introduction Colorectal cancer (CRC) is common with around 42,000 new diagnoses made annually in the UK [1]. Outcomes in the UK lag behind the rest of Europe despite nearly two decades of 2week-wait (2WW) pathways and other targets introduced to address this issue [2]. The desire for diagnosis at an earlier stage led to the introduction of broader referral criteria for
* J. A. Bailey [email protected] 1
Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, E Floor West Block, QMC Campus, Nottingham NG7 2UH, UK
2
Department of Clinical Chemistry, City Hospital, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
3
Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK
CRC in 2015 with the aim of investigating all those with a risk of CRC ≥ 3%. However, these criteria for urgent referral to secondary care are largely based on patient age and symptoms [3]—the latter are often associated with later-stage disease and are inherently non-specific. The search for objective markers that may help to stratify risk remains attractive in this context. We introduced
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