Abstract
Distant metastasis is a major cause of colorectal cancer–related death, but the mechanism
of tumour progression is not fully understood. There is growing evidence of an interaction
between tumour cells and platelets which may influence tumour progression and metastasis
formation. Quality and quantity of von Willebrand factor may regulate the interaction
between tumour cells and platelets. Our aim was to measure the platelet count, von
Willebrand factor antigen (VWF:Ag) levels and ADAMTS13 activity in a large (n = 232) cohort of colorectal cancer patients and to examine their relationships with
the stage of the disease and 5-year survival without thrombotic complications using
multivariable models. Significantly higher platelet counts (p = 0.005), VWF:Ag levels (p = 0.008) and decreased ADAMTS13 activity (p = 0.006) were observed in patients with metastatic disease. Results of the Kaplan–Meier
analysis showed that lower platelet counts (p < 0.0001), lower VWF:Ag (p = 0.0008) levels and higher ADAMTS13 activity (p < 0.0001) were associated with better event-free survival. Finally, to investigate
the association between overall event-free survival and the three study variables,
multivariate Cox proportional hazard models were generated. All models were adjusted
for age, gender and disease stage. Platelet count, ADAMTS13 activity or VWF:Ag level
were incorporated and all of these variables turned out to be age-, gender- and stage-independent
predictors of mortality (all hazard ratio >1.7, p < 0.05). In summary, this is the first observational study reporting association
between higher mortality or thrombotic complications and increased platelet count,
increased VWF:Ag levels and decreased ADAMTS13 activity in colorectal cancer.
Keywords
ADAMTS13 - platelet - von Willebrand factor - mortality - colorectal cancer
