术前血小板计数对喉鳞状细胞癌患者预后评估的意义

Clinical significance of preoperative platelet count in laryngeal squamous cell carcinoma prognosis

目的探讨术前血小板计数对喉鳞状细胞癌患者预后的影响。方法回顾性分析286例喉鳞状细胞癌患者的临床资料,确定血小板计数以复发及死亡为终点的最佳临界值,分析术前血小板计数对喉鳞状细胞癌患者术后复发及5年生存率的影响。结果以复发为终点的血小板计数的最佳临界值为242.5×109/L,将患者分为血小板计数≥242.5×109/L组(n=115)与血小板计数<242.5×109/L组(n=171),经单因素分析发现,喉癌患者术后复发与年龄(χ^2=0.005,P=0.942)、性别(χ^2=0.309,P=0.579)、病理分化程度(Z=2.858,P=0.240)无关,与T分期(χ^2=10.509,P=0.001)、淋巴结转移(χ^2=7.297,P=0.007)、肿瘤原发部位(χ^2=16.797,P<0.001)、术前血小板计数(χ^2=12.081,P=0.001)相关。进一步经多因素分析发现,T分期(OR=0.518,95%CI为0.281~0.954,P=0.035)、肿瘤原发部位(OR=2.371,95%CI为1.283~4.382,P=0.006)、血小板计数(OR=2.885,95%CI为1.607~5.179,P<0.001)是影响喉鳞状细胞癌患者术后复发的独立因素。以死亡为终点的血小板计数的最佳临界值为251.5×109/L,将患者分为血小板计数≥251.5×109/L组(n=94)与血小板计数<251.5×109/L组(n=192),经单因素分析发现,喉癌患者术后生存率与年龄(χ^2=0.030,P=0.863)、性别(χ2=0.000,P=0.945)、病理分化程度(χ^2=4.050,P=0.133)无关,与T分期(χ^2=41.630,P<0.001)、淋巴结转移(χ^2=58.110,P<0.001)、肿瘤原发部位(χ^2=36.250,P<0.001)、术前血小板计数(χ^2=4.790,P=0.029)相关。经多因素分析发现,T分期(HR=0.353,95%CI为0.193~0.645,P=0.001)、肿瘤原发部位(HR=2.151,95%CI为1.312~3.526,P=0.002)、淋巴结转移(HR=2.819,95%CI为1.633~4.867,P<0.001)、血小板计数(HR=1.853,95%CI为1.160~2.960,P=0.010)是影响喉鳞状细胞癌患者术后5年生存率的独立因素。Kaplan-Meier生存分析显示血小板计数≥251.5×109/L组与血小板计数<251.5×109/L组喉鳞状细胞癌患者5年生存率分别为58.23%、67.87%,组间比较差异有统计学意义(χ^2=4.79,P=0.029)。结论术前血小板计数水平是喉鳞状细胞癌患者术后复发和5年生存率的影响因素,对喉鳞状细胞癌患者预后的评估具有重要意义。

Objective To explore the effect of preoperative platelet (PLT) count on the prognosis of patients with laryngeal squamous cell carcinoma. Methods The clinical data of 286 patients with laryngeal squamous cell carcinoma were retrospectively analyzed to determine the optimal critical value of PLT count for end point of recurrence and death. The effects of preoperative PLT count on the recurrence and 5-year survival rates of patients with laryngeal squamous cell carcinoma after surgery were analyzed. Results The optimal critical value of PLT count for end point of recurrence was 242.5×109/L. The patients were divided into PLT≥242.5×109/L group (n=115) and PLT<242.5×109/L group (n=171). Single factor analysis indicated that the recurrence was not related to age (χ^2=0.005, P=0.942), gender (χ^2=0.309, P=0.579) and pathological differentiation (Z=2.858, P=0.240), and was related to T staging (χ^2=10.509, P=0.001), lymph node metastasis (χ^2=7.297, P=0.007), primary tumor site (χ^2=16.797, P<0.001) and preoperative PLT count (χ^2=12.081, P=0.001). Multivariate analysis indicated that T staging (OR=0.518, 95%CI: 0.281-0.954, P=0.035), primary tumor site (OR=2.371, 95%CI: 1.283-4.382, P=0.006), and PLT count (OR=2.885, 95%CI: 1.607-5.179, P<0.001) were the independent factors affecting the recurrence of laryngeal squamous cell carcinoma. The optimal critical value of PLT count for end point of death was 251.5×109/L. The patients were divided into PLT≥251.5×109/L group (n=94) and PLT<251.5×109/L group (n=192). Single factor analysis indicated that the 5-year survival rate was not related to age (χ^2=0.030, P=0.863), gender (χ^2=0.000, P=0.945) and pathological differentiation (χ^2=4.050, P=0.133), and was related to T staging (χ^2=41.630, P<0.001), lymph node metastasis (χ^2=58.110, P<0.001), primary tumor site (χ^2=36.250, P<0.001) and preoperative PLT count (χ^2=4.790, P=0.029). Multivariate analysis indicated that T staging (HR=0.353, 95%CI: 0.193-0.645, P=0.001), primary tumor site (HR=2.151, 95%CI: 1.312-3.526, P=0.002), lymph node metastasis (HR=2.819, 95%CI: 1.633-4.867, P<0.001), and PLT count (HR=1.853, 95%CI: 1.160-2.960, P=0.010) were the independent factors affecting 5-year survival rates of laryngeal squamous cell carcinoma. Kaplan-Meier survival analysis indicated that the 5-year survival rate of PLT≥251.5×109/L group and PLT<251.5×109/L group were 58.23%, 67.87%, with significant difference (χ^2=4.79, P=0.029). Conclusion Preoperative PLT count is the influence factor of recurrence and 5-year survival rate of laryngeal squamous cell carcinoma patients, which has important significance to the prognosis of laryngeal squamous cell carcinoma patients.