术前血小板计数和肿瘤最大径比对结直肠癌患者的预后分析

Prognostic implications of pre-operative platelet count to maximum tumor diameter ratio for colorectal cancer

背景术前血小板计数,肿瘤最大径可辅助判断结直肠癌(colorectal cancer,CRC)患者预后,结合两者可在一定程度上取长补短,准确判断患者预后.但目前在临床上,对于联合这两个参数,如血小板计数和肿瘤最大径比(platelet count and maximum tumor diameter ratio,PTR)是否可存在价值的报道较少.目的探讨术前PTR对CRC患者3年无进展生存期(progression free survival,PFS)的预测价值.方法收集解放军总医院海南医院自2012-12/2019-06经手术后病理确诊的结直肠腺癌患者127例,计算PTR并分析其在性别、年龄等不同临床临床参数中的差异和对PFS预测的价值.结果(1)PTR对患者3年PFS存在一定价值(AUC=0.66,95%CI:0.56-0.76,P<0.01),当其取值为57.27时,其对3年PFS预测的敏感性73.30%,特异性为56.10%;(2)以57.27为界,PTR高于界值的患者预后较好(Logrank=9.70,P<0.01),生存时间明显长于低于界值的患者(50.02 mo±22.33 mo vs 38.46 mo±24.39 mo,t=-2.76,P<0.01);(3)单因素分析显示术前癌胚抗原、糖类抗原199及TNM分期,PTR对患者生存存在影响(P<0.01),但多因素分析仅显示术前癌胚抗原、N及M分期是独立预测因子.结论PTR对CRC患者3年PFS预测存在一定价值,其中PTR较高的患者生存相对较好,但PTR不是患者预后的独立预测因子.

BACKGROUND Pre-operative platelet count and maximum tumor diameter are useful in predicting the prognosis of colorectal cancer patients,however,it is still largely unknown whether the combination of these two parameters,e.g.,the pre-operative platelet count to maximum tumor diameter ratio(PTR),could contribute to prognostic prediction for these patients.AIM To explore the prognostic role of pre-operative PTR in predicting the 3-year progression free survival(PFS)in colorectal cancer patients.METHODS A total of 127 patients who were pathologically confirmed with adenocarcinoma and underwent surgery were collected from December 2012 to June 2019 at Hainan Hospital of PLA General Hospital.The PTR was calculated and its prognostic significance for PFS were analyzed.RESULTS PTR displayed appreciated prediction value for the patients(AUC=0.66,95%CI:0.56-0.76,P<0.01),and when the cut-off value point was set at 57.27,it had a sensitivity and specificity of 73.30%and 56.10%,respectively.Patients with a high PTR had a better prognosis(log rank=9.70,P<0.01)and much longer PFS(50.02 mo±22.33 mo vs 38.46 mo±24.39 mo,t=-2.76,P<0.01)than those with a low PTR.Univariate analysis showed that preoperative carcinoembryonic antigen(CEA),carbohydrate antigen 199,TNM stage,and PTR could influence the PFS(P<0.01),but only pre-operative CEA,N stage,and M stage were identified to be independent prognostic factors by multivariate analysis.CONCLUSION PTR is helpful in predicating the 3-year PFS for colorectal cancer patients.An elevated PTR correlates with a good survival,but it is not an independent prognostic factor.