血小板与淋巴细胞比值对卵巢癌患者国际妇产科联盟临床分期的预测价值

Predictive value of plate-to-lymphocyte ratio for International Federation of Obstetrics and Gynecology staging of ovarian cancer patients

目的探讨血小板与淋巴细胞比值(PLR)对卵巢癌患者国际妇产科联盟(FIGO)临床分期的预测价值。方法选择2005年1月至2017年1月,于南充市中心医院就诊的225例初治卵巢癌患者为研究对象。采取回顾性分析方法,根据FIGO分期,将其分为早期卵巢癌组(n=85,FIGO分期为Ⅰ~Ⅱ期)和晚期卵巢癌组(n=140,FIGO分期为Ⅲ~Ⅳ期)。采用Wilcoxon秩和检验,对2组患者的年龄、人体质量指数(BMI)、白细胞计数、血红蛋白(Hb)水平、PLR和中性粒细胞与淋巴细胞比值(NLR)进行统计学分析。采用χ2检验,对2组患者的组织病理学类型、合并恶性腹水患者所占比例、血清CA125水平>35U/mL所占比例等进行统计学分析。绘制受试者工作特征(ROC)曲线,对PLR预测卵巢癌患者FIGO分期进行分析,并计算ROC曲线下面积(ROC-AUC)。采用多因素非条件logistic回归分析,判断PLR预测卵巢癌患者FIGO临床分期的准确性。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果①2组患者的年龄、BMI、Hb水平和白细胞计数比较,差异均无统计学意义(P>0.05);而其组织病理学类型、是否合并恶性腹水、血清CA125水平>35U/mL、PLR和NLR比较,则差异均有统计学意义(χ^2=16.897、76.187、11.817、-5.252、-3.790,P均<0.05)。②组织病理学类型(OR=2.460,95%CI=1.246~4.856,P=0.009),是否合并恶性腹水(OR=6.649,95%CI=3.437~12.862,P<0.001)和PLR(OR=1.005,95%CI=1.001~1.009,P=0.027),均为预测卵巢癌患者FIGO分期的独立危险因素。③PLR对预测卵巢癌患者FIGO分期的ROC-AUC为0.709(95%CI:0.645~0.767,P<0.001)。根据约登指数最大原则,PLR预测卵巢癌患者FIGO临床分期的最佳临界值为157.14。其中,本研究225例初治卵巢癌患者中,PLR>157.14者为134例,PLR≤157.14者为91例。此时,PLR对预测卵巢癌患者FIGO分期的敏感度为72.9%,特异度为63.5%。结论PLR值可预测卵巢癌FIGO分期。当PLR>157.14时,卵巢癌患者FIGO临床分期为晚期的可能性较大。

Objective To explore the predictive value of platelet-to-lymphocyte ratio (PLR) for International Federation of Obstetrics and Gynecology (FIGO) staging of ovarian cancer patients. Methods From January 2005 to January 2017, a total of 225 patients with primary ovarian cancer who were treated at Nanchong Central Hospital were selected into this study. According to different FIGO stagings, they were divided into early ovarian cancer group ( n =85, FIGO stage Ⅰ-Ⅱ) and advanced ovarian cancer group ( n =140, FIGO stage Ⅲ-Ⅳ). Wilcoxon rank sum test was used to statistically compare age, body mass index (BMI), white blood cell count, hemoglobin (Hb) level, PLR and neutrophil-to-lymphocyte ratio (NLR) between two groups. Chi-square test was used to statistically compare histopathological types, proportion of patients with ascites and proportion of serum CA 125 level > 35 U/mL. Then receiver operator characteristic (ROC) curve of PLR for predicting the FIGO staging of ovarian caner patients was drawn, and the area under ROC curve (ROC-AUC) was calculated. The optimal critical value of PLR for predicting the clincial staging of ovarian caner patients was obtained when the Youden index reaching the maximum value. And its sensitivity and specificity were calculated. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013. Informed consent was obtairned from each participates. Results ①There were significant differences in histopathological types, malignant ascites or not, serum CA 125 level > 35 U/mL, PLR and NLR between two groups (χ^2=16.897,76.187,11.817,-5.252,-3.790;P all<0.05), while there were no significant differences in age, BMI, Hb level and WBC count between two groups ( P >0.05).②Histopathological type ( OR =2.460, 95% CI =1.246-4.856, P =0.009), malignant ascites ( OR =6.649, 95% CI =3.437-12.862, P < 0.001) and PLR ( OR =1.005, 95% CI =1.001-1.009, P =0.027) were independent risk factors for ovarian cancer patients with different FIGO staging.③ROC curve analysis showed that PLR for predicting FIGO staging of ovarian cancer patients was 0.709 (95% CI : 0.645-0.767, P <0.001). According to the principle of maximum Youden index, the optimal critical value for PLR to predict FIGO staging of ovarian cancer patients was 157.14, of which 134 patients with PLR > 157.14 and 91 patients with PLR≤157.14. At this time, the sensitivity was 72.9%, and the specificity was 63.5%. Conclusions PLR value can predict FIGO staging of ovarian cancer. When PLR>157.14, the FIGO staging of ovarian cancer patients is more likely to be advanced.