术前红细胞分布宽度对非小细胞肺癌患者预后的评估价值

Prognostic value of preoperative red cell distribution width in patients with non-small cell lung cancer

目的:分析术前红细胞分布宽度(red cell distribution width,RDW)对非小细胞肺癌(non-small cell lung cancer,NSCLC)患者预后的评估价值。方法:回顾性分析2008年3月至2012年12月天津医科大学肿瘤医院行根治性手术的513例NSCLC患者的临床病理资料。根据受试者工作特征ROC曲线分析确定RDW的截断值。分别通过χ2、t或秩和检验分析RDW与临床病理特征和实验室变量之间的关系,采用Kaplan-Meier法进行生存分析,Log-rank检验组间生存差异。采用Cox比例风险回归模型进行多因素分析。结果:根据ROC曲线,术前RDW最佳截断值为12.95%。其中RDW≤12.95%为250例,RDW>12.95%为263例。术前RDW与年龄、血红蛋白、白蛋白、纤维蛋白原和D-二聚体水平显著相关(均P<0.05)。单因素分析显示肿瘤位置、病理分期、血小板数目、白蛋白、血红蛋白、纤维蛋白原和术前RDW是影响NSCLC患者预后的因素(均P<0.05);多因素分析显示术前RDW和病理分期是影响NSCLC患者预后的独立危险因素(均P<0.05)。结论:术前RDW水平可作为预测行根治性手术的NSCLC患者预后的指标。

Objective： To analyze the prognostic value of preoperative red cell distribution width（RDW） in patients with non-small cell lung cancer. Methods： A retrospective study of 513 patients with NSCLC who underwent surgery was conducted at the Tianjin Medical University Cancer Institute and Hospital from March 2008 to December 2012. The preoperative RDW cut-off value was determined using a receiver operating characteristic（ROC） curve analysis. The Chi-square test, t test, or Mann-Whitney U test was used to analyze the correlations between preoperative RDW and clinicopathological and clinicolaboratory variables. The Kaplan-Meier method and the Log-rank test were used to compare the survival curves. Hazard ratios（HRs） and 95% confidence intervals（95% CIs） were calculated by univariate and multivariate analyses, using the Cox proportional hazards model. Results： According to the ROC curve analysis, the optimal preoperative RDW cut-off value was 12.95%. The RDW≤12.95% cut-off identified 250 patients, and the RDW ≤12.95% identified263 patients. The preoperative RDW was associated with age, hemoglobin, albumin, fibrinogen, and D-dimer（all P0.05）. The univariate analysis showed that tumor location, pathological stage, platelet count, albumin, hemoglobin, fibrinogen, and the preoperative RDW affected the prognosis of patients with NSCLC（all P0.05）. The multivariate analysis demonstrated that the preoperative RDW remained an independent prognostic factor of disease-free and overall survivals, along with pathological stage（all P0.05）. Conclusions：The preoperative RDW was able to predict the prognosis of NSCLC patients who undergo radical operation.