结直肠癌患者手术前后血小板计数及其变化与预后相关性研究

The Study of Correlation between the Perioperative Platelet Counts and Changes with the Prognosis in Colorectal Cancer

目的：探讨手术前后血小板（PLT）计数及其变化对结直肠癌患者预后的影响。方法回顾性分析肿瘤外科260例行结直肠癌根治术患者的临床资料，根据手术前后PLT计数分为术前正常PLT组（PLT＜300×10^9/L）和术前高PLT组（PLT≥300×10^9/L），同理分为术后正常PLT组和术后高PLT组，另按照手术前后PLT计数的变化，分为术后PLT升高组、术后PLT降低组，采用log-rank单因素生存分析和COX回归模型进行生存分析。结果单因素生存分析显示术前正常PLT组的生存优于术前高PLT组；而术后高PLT组的生存优于术后正常PLT组，进一步的分析显示术后PLT升高组的生存优于术后PLT降低组，虽然以上三组比较无统计学意义，但两条生存曲线有进一步分离的趋势；多因素分析显示术前PLT≥300×10^9/L（RR：0.553；95%CI：0.318～0.962；P=0.036）和术后PLT＜30×10^9/L（RR：1.824；95%CI：1.006～3.308；P=0.048）都是影响结直肠癌预后的独立危险因素。结论手术前后PLT的异常升高对结直肠癌预后判断作用相反，其机制可能与部分结直肠癌细胞分泌促血小板生长因子有关，而具有该分泌功能的结直肠癌与不良预后相关。

Objective To investigate the effect of platelet （PLT） count and their change on the prognosis of colorectal cancer patients before and after surgery. Methods Retrospective analysis of clinical data of 260 colorectal cancer patients undergoing radical resection by our surgical oncology were done. All cases were divided into normal platelet group （PLT〈300 ×10^9/L） and high platelet group （PLT≥300×10^9/L） according to the platelet counts before and after surgery, and all cases were also divided into postoperative platelet elevated group and reduced group according to changes in perioperative platelet counts. The overall survival rates were analyzed by univariate analysis and COX regression model. Results Univariate survival analysis demonstrates that survival in preoperative normal platelet group is better than high platelet group, while the result is opposite in postoperative cases. Further analysis shows that survival in postoperative platelet elevated group is better than platelet reduced group. Though differences between these groups were not statistically significant, but the two survival curves had a tendency to further separation. Multivariate analysis showed PLT≥300 ×10^9/L before surgery （RR：0.553;95%CI：0.318~0.962;P=0.036） and PLT〈300 ×10^9/L after surgery （RR：1.824;95%CI：1.006~3.308;P=0.048） were both independent risk factors affecting the prognosis of colorectal cancer. Conclusion Abnormal rise of platelet counts before and after surgery have opposite effect in colorectal cancer prognosis. The mechanism may be that part of colorectal cancer cells have the ability of secreting factor to promote platelet growth, whereas having the secretory function is associated with a poor prognosis.