血小板分布宽度对鼻咽癌患者预后的影响

Influences of platelet distribution width on the prognosis of patients with nasopharyngeal cancer

目的探讨血小板分布宽度（PDW）对鼻咽癌患者预后的影响。方法选择2009年1月至2013年12月我院收治的鼻咽癌患者186例，年龄48～79岁，平均年龄（61.8±8.2）岁。记录患者年龄、性别、肺功能、肝功能、身体质量指数、吸烟、饮酒、组织学分型、分期等检查指标。患者出院后进行随访，平均随访时间为28个月（12～36个月），终点事件为患者因鼻咽癌相关的死亡或随访结束。检测PDW反映患者总体生存率的受试者工作特征（ROC）曲线最佳临界值，据其将患者分为≥临界值组和＜临界值组。采用单因素和Cox多元回归分析影响鼻咽癌的预后因素。结果PDW反映患者总体生存率的ROC曲线最佳临界值为16.4%，将患者分为PDW≥16.4%和PDW＜16.4%两组，两组患者在年龄（t=0.712，P=0.478）、性别（χ2=0.044,P=0.834）、身体质量指数（t=0.593，P=0.554）、吸烟（χ2=0.063，P=0.802）、饮酒（χ2=0.555，P=0.456）、第1秒用力呼气量/用力肺活量（FEV1/FVC，t=1.711，P=0.089）、谷丙转氨酶（ALT，t=1.756，P=0.081）、组织学分型（χ2=0.259，P=0.879）和分期（Z=2.443，P=0.486）方面的差异无统计学意义。单因素分析结果显示，不同年龄（χ2=4.611，P=0.032）、性别（χ2=3.952，P=0.047）、吸烟（χ2=5.564，P=0.018）、FEV1/FVC（χ2=4.321，P=0.038）、分期（χ2=6.021，P=0.014）和PDW（χ2=4.511，P=0.034）患者的预后差异具有统计学意义。Cox多元回归分析结果显示高龄（≥60岁）（χ2=5.429，P=0.020）、男性患者（χ2=4.648，P=0.031）、吸烟（χ2=18.453，P〈0.001）、Ⅲ～Ⅳ期（χ2=9.612，P=0.002）和PDW≥16.4%（χ2=6.008，P=0.014）是影响鼻咽癌患者预后的独立危险因素。结论鼻咽癌患者PDW高低影响患者的预后，PDW≥16.4%的患者预后较好。

ObjectiveTo investigate the influences of platelet distribution width （PDW） on the prognosis of nasopharyngeal cancer patients. MethodsA total of 186 patients with nasopharyngeal cancer from January 2009 to December 2013 in our hospital were selected. The patients were aged from 48 to 79 years old, with an average age （61.8±8.2） years old. The age, gender, lung function, liver function, body mass index（BMI）, smoking, drinking, histological type and staging of patients were recorded. The patients were followed up after discharge, and the mean follow up period was 28 months （1236 months）. The terminal event was nasopharyngeal cancer related death or the end of follow up. The best threshold of receiver operating characteristic （ROC） curve for the overall survival rate of PDW was tested, and the patients were divided into ≥ best threshold group and ＜ best threshold group. The prognostic factors were analyzed by single factor analysis and Cox multiple regression analysis. ResultsThe best threshold of ROC curve for the overall survival rate of PDW was 16.4%. The patients were divided into PDW≥16.4% group and PDW＜16.4% group. There were no statistically significant differences in age （t=0.712, P=0.478）, gender （χ2=0.044, P=0.834）, BMI （t=0.593, P=0.554）, smoking （χ2=0.063, P=0.802）, drinking （χ2=0.555, P=0.456）, forced expiratory volume in one second/forced vital capacity （FEV1/FVC, t=1.711, P=0.089）, alanine transaminase （ALT, t=1.756, P=0.081）, histological type （χ2=0.259, P=0.879） and staging （Z=2.443, P=0.486） between the two groups. Results of single factor analysis showed that there were statistically significant differences in age （χ2=4.611, P=0.032）, gender （χ2=3.952, P=0.047）, smoking （χ2=5.564, P=0.018）, FEV1/FVC （χ2=4.321, P=0.038）, staging （χ2=6.021, P=0.014） and PDW （χ2=4.511, P=0.034） between the two groups. Cox risk model of multifactor analysis showed that the elderly （≥60 years, χ2=5.429, P=0.020）, male patients （χ2=4.648, P=0.031）, smoking （χ2=18.453, P〈0.001）, ⅢⅣ staging （χ2=9.612, P=0.002） and PDW≥16.4% （χ2=6.008, P=0.014） were independent prognostic factors in patients with nasopharyngeal cancer. ConclusionThe degree of PDW in patients with nasopharyngeal cancer affects the prognosis of patients, and the patients with PDW≥16.4% have the better prognosis.