血小板体积指数对可切除食管鳞状细胞癌患者预后的评估价值

Prognostic value of platelet volume indices in patients with resectable esophageal squamous cell carcinoma

目的探讨术前血小板体积指数(PVI)对可切除食管鳞状细胞癌(ESCC)患者预后的评估价值。方法回顾性分析2013-03至2023-06进行手术治疗的210例ESCC患者的临床资料,根据患者术前各项PVI指数的受试者工作特征曲线(ROC)获得截断值,Kaplan-Meier方法和COX模型分析了PVI对ESCC患者预后的影响。结果随访5年,125例(59.52%)患者死亡,中位OS为15.0个月(范围3~60个月)。与存活组比较,死亡组血小板计数(PLT)[250.50(205.0,300.50)vs.212.50(179.50,278.50),Z=-2.801,P=0.005]、血小板分布宽度(PDW)[12.90(11.80,15.80)FL vs.11.30(10.40,14.95)FL,Z=-2.665,P=0.008]均有所升高(P<0.05),PDW/PLT[12.90(11.80,15.80)vs.11.30(10.20,15.05),Z=-6.719,P<0.001]显著升高,平均血小板体积(MPV)/PLT[0.04(0.03,0.04)vs.0.05(0.04,0.06),Z=-10.847,P<0.001]显著降低。受试者工作特征曲线显示PLT、PDW、MPV/PLT、PDW/PLT都可以用于预测可切除ESCC患者的死亡风险(P<0.05),但PLT、PDW的临床价值不高[曲线下面积(AUC)<0.7];当MPV/PLT≥0.043或PDW/PLT≥60.230时,AUC值分别为0.771和0.802;当两者联合时,预测死亡风险的AUC值升高至0.929。相对MPV/PLT>0.043、PDW/PLT≤60.230的患者,MPV/PLT≤0.043(Log-Rank=34.502,P<0.001)、PDW/PLT>60.230(Log-Rank=172.056,P<0.001)的ESCC患者总生存期(OS)更短。经COX多因素模型分析,发现PDW/PLT>60.230、MPV/PLT>0.043与ESCC患者术后死亡独立相关(P<0.05)。结论PVI是可切除ESCC患者术后的潜在预后指标,尤其是MPV/PLT和PDW/PLT联合检测的临床预后价值更理想。

Objective To evaluate the prognostic value of platelet volume indices(PVI)in patients with resectable esophageal squamous cell carcinoma(ESCC).Methods Clinical data of 210 patients with ESCC who underwent surgery from March 2013 to June 2023 were retrospectively analyzed,and the cut-off values of PVI were obtained from the receiver operating characteristic curve(ROC),and the Kaplan-Meier method and COX model were used to analyze the effect of PVI index on the prognosis of ESCC patients.Results During a 5-year follow-up,125 patients(59.52%)died,with a median OS of 15.0 months(range of 3-60 months).Compared with the survival group,platelet count(PLT)in the death group[250.50(205.0,300.50)vs.212.50(179.50,278.50),Z=-2.801,P=0.005],platelet distribution width(PDW)in the death group[12.90(11.80,15.80)FL vs.11.30(10.40,14.95)FL,Z=-2.665,P=0.008]increased(P<0.05),PDW/PLT[12.90(11.80,15.80)vs.11.30(10.20,15.05),Z=-6.719,P<0.001]significantly increased,and the mean platelet volume(MPV)/PLT significantly decreased[0.04(0.03,0.04)vs.0.05(0.04,0.06),Z=-10.847,P<0.001].The receiver operating characteristic curve showed that PLT,PDW,MPV/PLT and PDW/PLT could all be used to predict the mortality risk of patients with resectable ESCC,P<0.05,but the clinical value of PLT and PDW was not high[area under the curve(AUC)<0.7];when MPV/PLT≥0.043 or PDW/PLT≥60.230,the AUC values were 0.771 and 0.802,respectively,and when the two were combined,the AUC values for predicting mortality risk increased to 0.929.Compared with patients with MPV/PLT>0.043 and PDW/PLT≤60.230,the overall survival(OS)of ESCC patients with MPV/PLT≤0.043(Log-Rank=34.502,P<0.001)and PDW/PLT>60.230(Log-Rank=172.056,P<0.001)was shorter.The COX multivariate model analysis showed that PDW/PLT>60.230 and MPV/PLT>0.043 were independently associated with postoperative mortality in ESCC patients(P<0.05).Conclusions PVI is a potential prognostic indicator for resectable ESCC patients after surgery,especially the clinical prognostic value of combined detection of MPV/PLT and PDW/PLT is more ideal.