As larger platelets are more reactive in response to stimuli, selective consumption of larger platelets might occur.

Consequently, the MPV of circulating platelets would be decreased. Micro- and macro-thromboembolic events are one of the major complications for patients with advanced NSCLC and can be fatal [27], [28] and [29]. Therefore, this may be a possible explanation for the poor prognosis of patients with a low MPV/PC ratio. The MPV and PC were also significant prognostic factors for OS in univariate analyses (P = −0.0270 and P = 0.0124, respectively). However, multivariate analysis did not indicate the superiority of them against the MPV/PC ratio when considered independently (HR of a low MPV/PC ratio: 1.668 [P = 0.0008], HR of a low MPV: 1.381 [P = 0.0121], and HR of a high PC: 1.380 [P = 0.0114]). Therefore, we concluded that the MPV/PC ratio was a more reliable and accurate selleck inhibitor biomarker than the MPV or PC alone. Despite the retrospective nature and small size of the present study, our results clearly demonstrated that a low MPV/PC ratio at initial diagnosis was an independent unfavorable prognostic factor

for patients with advanced NSCLC. Further investigation should clarify the etiology by which the amount and volume of circulating platelets modulate mortality in patients with NSCLC. The authors have declared no conflict of interest. “
“Over the past selleck kinase inhibitor Grape seed extract two decades, the

mortality attributed to lung cancer has increased and it is now the leading cause of cancer deaths [1]. Late diagnosis is a fundamental obstacle to improving the outcomes of lung cancer, with more than 70% of new cases presenting too late for curative treatment to be attempted [2]. Owing to the development of new chemotherapeutic agents, the costs of care for inoperable lung cancer are growing rapidly [3]. Therefore, it is worth examining the lifetime utility difference for patients with operable and inoperable lung cancer, which emphasizes the importance of early diagnosis of lung cancer. For the assessment of lifetime utility difference, both survival and quality-of-life (QoL) should be taken into consideration, and thus, the quality-adjusted life year (QALY) unit is more suitable than estimating survival alone for comparison of various types of healthcare services [4]. Quality-adjusted life expectancy (QALE) can be estimated via adjusting the survival function with the mean QoL at each time point, t, using the following equation [5], [6] and [7]: QALE=∫E[QoL(t/x)]S(t/x)dtQALE=∫EQoLt/xSt/xdtE[QoL(t/x)] denotes the expected value of health state (QoL) for patients with condition x at time t and S(t/x) denotes the survival function for condition x at time t. Previous studies discussing the benefits of surgery mostly focused on survival alone, and usually did not take lead-time bias into consideration [8].