This study suggested that MPV and PLT measurements and other CBC parameters were not significantly different from controls in PTC patients.
Giardi et al. 23 retrospectively evaluated 517 patients submitted to thyroidectomy. Of their patient, 83.2% of 95 patients with PTC were females, which is in good agreement with the results of the present study.
In the history of infection and inflammation, there are many types of cancer. Inflammation is an essential and critical phase in the production and progression of cancer24. Tumor cells release cytokines such as IL-1, IL 6, and other growth factors that promote platelet production, and activated platelets are involved in each cancer development step. Platelets also play a significant metabolic function in cancer pathogenesis through their angiogenic, metastatic, and proteolytic activity in the context of inflammation 25. Platelets provide the production and release of VEGF, which plays a role in tumor angiogenesis and inflammation26. Furthermore, elevated platelet levels have been observed in several types of cancers in association with increased risk of recurrence, later stages, and metastasis 27.
PTC analyses a persistent inflammation-related disease. Beksac et al 28found that IL-6 in presurgical samples was higher in PTC and returned to normal after surgery in PTC patients. Similarly, in patients with PTC, Kobawala et al. 29 demonstrated that IL-6 rates were significantly higher in patients with mild thyroid disease and that its levels were strongly associated with tumor intensity, extrathyroid expansion, and distant metastasis. enhanced generation of platelets may contribute to the occurrence of large thrombocytes, resulting in elevated PDW rates 30
The number of platelets has been investigated in several different studies in organ cancer. For instance, in cases of non-small cell lung cancer and epithelial ovarian cancer, PLT levels were shown to be significantly lower, but there was no difference in breast and colon cancer27,31−34. Balden et al. 35 demonstrated that there was no significant difference between PCT and control groups regarding PLT. In this study, the PTC patient had a lower PLT count compared to the control group. However, analysis of the ROC curve shows that this factor obtained a poor AUC score (AUC tests ≤ 0.75 are generally considered not to be clinically useful).
MPV has been reported for many types of cancer. Preferably, MPV rates in endometrial cancer21, ovarian cancer19, colorectal cancer20, and gastric cancer 36 be significantly increased relative to healthy controls. Larger platelets are more involved in metabolism and enzymes than smaller platelets. MPV is a repressive platelet function, and substantial evidence demonstrates that MPV is an important biological variable17.
Baldane et al. 35 found that MPV in PTC cases was significantly higher than benign goiters and healthy controls and MPV values returned to normal postoperatively. However, in our analysis, we found a significant difference in MPV rates among the groups. However, due to the low AUC score, it cannot be used as a diagnostic factor. One possible explanation for this may be that during the inflammatory response, platelets are recruited to the region of inflammation where they are damaged and their volume is reduced15,37. Based on this, it has been suggested that large platelet production boosts in bone marrow in patients with PTC, but platelet consumption and conversion of large platelets to small platelets also increase in the inflammatory area; therefore, platelet counts and MPV may probably remain unchanged 38.
The factors that stimulate platelet production often increase the width of the platelet distribution.PDW illustrates the increase in platelet size and indicates rapid platelet release39,40. Dincel and Bayraktar 39 observed that relative to multinodular goiter patients and normal healthy participants, PDW decreased in patients with PTC. Yaylaci et al 41 found that PDW in the papillary cancer group was significantly lower than in healthy goiters. In contrast, Li et al. 42 observed that PDW was higher than normal in patients with thyroid cancer and higher in patients with papillary carcinoma compared to follicular and medullary carcinoma. This study was unable to demonstrate any significant differences in PDW between groups.
The basic hematological function of parameters such as the neutrophil-to-lymphocyte ratio, the platelet-to-lymphocyte ratio was also analyzed 22,43,44. High NLR levels are attributed to either neutrophilia or lymphopenia. Neutrophilia affects the immune system by eliminating the cytolytic ability of lymphocytes, activated T cells, and natural killer cells45. Common factors in neutrophilia or lymphopenia are dysregulation of the release of cytokines, chemokines, and growth factors produced by both tumor cells and related tumor microenvironment host cells46. In another study, a specific increase in NLR was found in papillary and micropapillary carcinomas compared to benign goiters and controls, although no cut-off was suggested22. However, the findings of the current study do not support previous research. We observed significantly higher NLR values in patients with PTC, which was also not known for PLR. In addition, analysis of the ROC curve revealed that both variables achieved lower AUC scores. These results are in agreement with the findings of other studies in which no differences between PTC and control groups were found in NLR, PLR [6, 9, 10].
These results may be explained by the fact that in thyroid carcinogenesis, chronic inflammation may be less important46,47. Moreover, these indices are mainly unspecified and require careful screening of patients with strict exclusion criteria because they are affected by a multitude of medical conditions, illnesses, and medicines 47. In addition, constitutional differences between individuals, such as different subtypes of HLA, may lead to differential systemic inflammatory responses to various exogenous and endogenous stimuli 17,22.
Our study has a number of limitations. Our analysis is a retrospective review in a single institution and the sample size was relatively small. More prospective largescale research is necessary to evaluate shifts in platelet indices in benign and malignant thyroid diseases.