血小板分布宽度对神经母细胞瘤预后的预测价值

Predictive value of platelet distribution width on prognosis of neuroblastoma

目的探讨血小板分布宽度(PDW)能否有效预测神经母细胞瘤(NB)患儿的预后。方法回顾性分析2014年1月至2018年1月郑州大学第一附属医院初治的67例NB患儿的临床资料,根据PDW分为低PDW组与高PDW组,比较2组患儿临床指标的差异,并采用Kaplan-Meier方法和Cox回归模型评价PDW的预后评估价值。结果67例NB患儿中男41例,女26例,男女比例为1.58∶1.00;平均年龄为44个月(2~156个月);Ⅰ期5例,Ⅱ期1例,Ⅲ期15例,Ⅳ期46例。诊断时年龄≤18个月14例,>18个月53例,初诊神经元特异性烯醇化酶(NSE)水平≥100μg/L者47例,<100μg/L者20例。随访中位时间为20.4个月,至随访结束死亡35例,存活32例。低PDW组与高PDW组患儿在年龄、性别、首发部位、分期、平均血小板体积等方面差异均无统计学意义(均P>0.05)。高PDW组高危患儿比例、NSE水平、骨髓转移率、MYCN基因扩增率、红细胞分布宽度等均高于低PDW组,而血小板压积则低于低PDW组,差异均有统计学意义(均P<0.05)。生存率分析显示,低PDW组2年生存率显著高于高PDW组(69.8%比25.3%,χ^2=15.761,P<0.05)。单变量分析表明,NSE(HR=6.606,95%CI:2.018~21.620),MYCN基因(HR=1.977,95%CI:0.794~4.919),危险度分层(HR=5.926,95%CI:1.416~24.794),PDW(HR=4.036,95%CI:1.957~8.322),红细胞分布宽度(HR=1.120,95%CI:1.005~1.249)等因素为NB预后不良的危险因素;血小板压积(HR=0.012,95%CI:0.000~0.427)为NB预后良好的保护因素。多变量分析表明,PDW是NB患儿的独立危险因素(HR=2.524,95%CI:1.017~6.264,P=0.046)。结论PDW增高和已知的NB患儿预后危险因素、肿瘤标志物升高及骨髓转移有较好的一致性,PDW增高与NB预后较差相关,且PDW是NB预后不良的独立危险因素。

Objective To discuss whether platelet distribution width(PDW)can effectively predict the prognosis of neuroblastoma(NB).Methods The clinical data of 67 NB patients in the First Affiliated Hospital of Zhengzhou University between January 2014 and January 2018 were retrospectively analyzed.They were divided into low PDW group and high PDW group according to the PDW level,and the differences in clinical indicators between the 2 groups were compared.The prognostic effects of PDW were assessed by using the Kaplan-Meier method and Cox regression model.Results Among the 67 patients,41 cases were male,26 cases were female,with the ratio of male to female being 1.58∶1.00,and the average age was 44 months(2-156 months).Five cases were in stageⅠ,1 case in stageⅡ,15 cases in stageⅢand 46 cases in stageⅣ.At the first time of diagnosis,there were 14 cases with age≤18 months,53 cases with age>18 months,47 cases with neuron specific enolase(NSE)level≥100μg/L,20 cases with NSE level<100μg/L.The median follow-up time was 20.4 months.At the end of follow-up,35 cases died and 32 cases survived.There was no statistical difference in age,gender,primary site of tumor,tumor stage and mean platelet volume between the low PDW group and the high PDW group(all P>0.05).The proportion of high-risk patients,the level of NSE,bone marrow metastasis rate,MYCN gene amplification rate and the red blood cell distribution width in the high PDW group were significantly higher than those in the low PDW group,but the high PDW group had a lower level of thrombocytocrit than the low PDW group,and the differences were statistically significant(all P<0.05).Survival analysis revealed that the 2-year overall survival of the low PDW group was significantly higher than that of the high PDW group(69.8%vs.25.3%,χ^2=15.761,P<0.05).Univariate analysis showed that NSE(HR=6.606,95%CI:2.018-21.620),MYCN gene(HR=1.977,95%CI:0.794-4.919),tumor risk stratification(HR=5.926,95%CI:1.416-24.794),PDW(HR=4.036,95%CI:1.957-8.322),and red blood cell distribution width(HR=1.120,95%CI:1.005-1.249)were the adverse factors affecting the overall survival,and thrombocytocrit was a protective factor for the prognosis of NB.Multivariate analysis indicated that PDW was an independent risk factor of NB(HR=2.524,95%CI:1.017-6.264,P=0.046).Conclusions There is a good consistency between the increase of PDW and the known prognostic risk factors,elevated tumor markers and bone marrow metastasis.Increased PDW is associated with poor prognosis in NB patients,and PDW is an independent risk factor for the poor prognosis of NB.