***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The mechanisms of paraneoplastic thrombocytosis in ovarian cancer and the role that platelets play in abetting cancer growth are unclear . METHODS We analyzed clinical data on 619 patients with epithelial ovarian cancer to test associations between platelet counts and disease outcome . Human sample s and mouse models of epithelial ovarian cancer were used to explore the underlying mechanisms of paraneoplastic thrombocytosis . The effects of platelets on tumor growth and angiogenesis were ascertained . RESULTS Thrombocytosis was significantly associated with advanced disease and shortened survival . Plasma levels of thrombopoietin and interleukin-6 were significantly elevated in patients who had thrombocytosis as compared with those who did not . In mouse models , increased hepatic thrombopoietin synthesis in response to tumor-derived interleukin-6 was an underlying mechanism of paraneoplastic thrombocytosis . Tumor-derived interleukin-6 and hepatic thrombopoietin were also linked to thrombocytosis in patients . Silencing thrombopoietin and interleukin-6 abrogated thrombocytosis in tumor-bearing mice . Anti-interleukin-6 antibody treatment significantly reduced platelet counts in tumor-bearing mice and in patients with epithelial ovarian cancer . In addition , neutralizing interleukin-6 significantly enhanced the therapeutic efficacy of paclitaxel in mouse models of epithelial ovarian cancer . The use of an antiplatelet antibody to halve platelet counts in tumor-bearing mice significantly reduced tumor growth and angiogenesis . CONCLUSIONS These findings support the existence of a paracrine circuit wherein increased production of thrombopoietic cytokines in tumor and host tissue leads to paraneoplastic thrombocytosis , which fuels tumor growth . We speculate that countering paraneoplastic thrombocytosis either directly or indirectly by targeting these cytokines may have therapeutic potential . ( Funded by the National Cancer Institute and others . ) BACKGROUND Stage Ib and IIa cervical carcinoma can be cured by radical surgery or radiotherapy . These two procedures are equally effective , but differ in associated morbidity and type of complications . In this prospect i ve r and omised trial of radiotherapy versus surgery , our aim was to assess the 5-year survival and the rate and pattern of complications and recurrences associated with each treatment . METHODS Between September , 1986 , and December , 1991 , 469 women with newly diagnosed stage Ib and IIa cervical carcinoma were referred to our institute . 343 eligible patients were r and omised : 172 to surgery and 171 to radical radiotherapy . Adjuvant radiotherapy was delivered after surgery for women with surgical stage pT2b or greater , less than 3 mm of safe cervical stroma , cut-through , or positive nodes . The primary outcome measures were 5-year survival and the rate of complications . The analysis of survival and recurrence was by intention to treat and analysis of complications was by treatment delivered . FINDINGS 170 patients in the surgery group and 167 in the radiotherapy group were included in the intention-to-treat analysis ; scheduled treatment was delivered to 169 and 158 women , respectively , 62 of 114 women with cervical diameters of 4 cm or smaller and 46 of 55 with diameters larger than 4 cm received adjuvant therapy . After a median follow-up of 87 ( range 57 - 120 ) months , 5-year overall and disease-free survival were identical in the surgery and radiotherapy groups ( 83 % and 74 % , respectively , for both groups ) , 86 women developed recurrent disease : 42 ( 25 % ) in the surgery group and 44 ( 26 % ) in the radiotherapy group . Significant factors for survival in univariate and multivariate analyses were : cervical diameter , positive lymphangiography , and adeno-carcinomatous histotype . 48 ( 28 % ) surgery-group patients had severe morbidity compared with 19 ( 12 % ) radiotherapy-group patients ( p = 0.0004 ) . INTERPRETATION There is no treatment of choice for early-stage cervical carcinoma in terms of overall or disease-free survival . The combination of surgery and radiotherapy has the worst morbidity , especially urological complications . The optimum therapy for each patient should take account of clinical factors such as menopausal status , age , medical illness , histological type , and cervical diameter to yield the best cure with minimum complications PURPOSE To report mature results of a r and omized trial that compared extended-field radiotherapy ( EFRT ) versus pelvic radiotherapy with concomitant fluorouracil and cisplatin ( CTRT ) in women with locoregionally advanced carcinomas of the uterine cervix . PATIENTS AND METHODS Four hundred three women with cervical cancer were r and omly assigned to receive either EFRT or CTRT .  Patients were eligible if they had stage IIB to IVA disease , stage IB to IIA disease with a tumor diameter > or = 5 cm , or positive pelvic lymph nodes . Patients were stratified by stage and by method of lymph node evaluation . RESULTS The median follow-up time for 228 surviving patients was 6.6 years . The overall survival rate for patients treated with CTRT was significantly greater than that for patients treated with EFRT ( 67 % v 41 % at 8 years ; P < .0001 ) . There was an overall reduction in the risk of disease recurrence of 51 % ( 95 % CI , 36 % to 66 % ) for patients who received CTRT . Patients with stage IB to IIB disease who received CTRT had better overall and disease-free survival than those treated with EFRT ( P < .0001 ) ; 116 patients with stage III to IVA disease had better disease-free survival ( P = .05 ) and a trend toward better overall survival ( P = .07 ) if they were r and omly assigned to CTRT . The rate of serious late complications of treatment was similar for the two treatment arms . CONCLUSION Mature analysis confirms that the addition of fluorouracil and cisplatin to radiotherapy significantly improved the survival rate of women with locally advanced cervical cancer without increasing the rate of late treatment-related side effects A total of 308,036 women were selected from the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) study to evaluate the association between tobacco smoking and the risk of cervical intraepithelial neoplasia of grade 3 (CIN3)/carcinoma in situ ( CIS ) and invasive cervical cancer ( ICC ) . At baseline , participants completed a  question naire and provided blood sample s. During a mean follow-up time of 9 years , 261 ICC cases and 804 CIN3/CIS cases were reported . In a nested case-control study , the baseline sera from 609 cases and 1,218 matched controls were tested for L1 antibodies against HPV types 11 , 16 , 18 , 31 , 33 , 35 , 45 , 52 , 58 , and antibodies against Chlamydia trachomatis ( CT ) , and Human Herpes Virus 2 ( HHV-2 ) . Cervical sample s were not available for HPV-DNA analysis in this study . Multivariate analyses were used to estimate associations between smoking and risk of CIN3/CIS and ICC in the cohort and the case-control studies . In the cohort analyses smoking status , duration and intensity showed a two-fold increased risk of CIN3/CIS and ICC , while time since quitting was associated with a two-fold reduced risk . In the nested case-control study , consistent associations were observed after adjustment for HPV , CT and HHV-2 serostatus , in both HPV seronegative and seropositive women . Results from this large prospect i ve study confirm the role of tobacco smoking as an important risk factor for both CIN3/CIS and ICC , even after taking into account HPV exposure as determined by HPV serology . The strong beneficial effect of quitting smoking is an important finding that will further support public health policies for smoking cessation OBJECTIVE The aim of this study was to determine the incidence of thrombocytosis and its possible impact on survival probability among women with locally advanced cervical carcinoma . METHODS The data base of 294 patients with Stages IIB-IVA cervical carcinoma without periaortic node metastasis who were treated with st and ardized radiation therapy and concurrent hydroxyurea or misonidazole was analyzed . Pretreatment platelet counts were available for 291 patients who are the subject of this study . RESULTS Thrombocytosis ( platelet count > 400 x 10(9)/liter ) was present in 86 ( 29.6 % ) of the 291 patients . A multivariate Cox proportional hazards model showed that patients without extrapelvic disease and with thrombocytosis had a 55 % greater chance of dying than those without thrombocytosis ( relative risk = 1.55 , 95 % confidence interval 1.08 - 2.21 ) . Patients with thrombocytosis had larger tumors and more frequently had bilateral parametrial involvement , tumor fixation to the sidewall , and positive pelvic lymph nodes than patients without thrombocytosis . Thrombocytosis was not found to be a prognostic factor in patients with positive pelvic nodes . However , in patients with negative pelvic nodes , the presence or absence of thrombocytosis was related to survival . CONCLUSION Thrombocytosis is a frequent finding among patients with advanced cervical carcinoma and seems to be related to tumor burden . Among patients with locally advanced cervical carcinoma who had negative pelvic nodes , those with thrombocytosis had a poorer survival 
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Conclusion The findings of this study indicated that an elevated platelet count before treatment was associated with poor OS , PFS , and RFS .