术前外周血中性粒细胞与淋巴细胞比值和血小板分布宽度对髓母细胞瘤患儿临床预后的影响

Effect of preoperative peripheral blood neutrophil to lymphocyte ratio and platelet distribution width on clinical prognosis of childhood medulloblastoma

目的探讨术前外周血中性粒细胞与淋巴细胞比值(NLR)、血小板分布宽度(PDW)对髓母细胞瘤患儿临床预后的影响。方法选取2009年1月至2016年12月郑州大学第一附属医院收治的术后病理结果证实为髓母细胞瘤的患儿76例,收集其临床资料及生存资料。采用Kaplan-Meier法计算总生存期(OS)和无进展生存期(EFS)的生存率,Log-rank检验比较各组的生存率,Cox模型比例风险评估行多因素分析。结果Log-rank检验示:高NLR组(NLR>4.94)的5年PFS率和OS率(22.2%、22.2%)低于低NLR组(NLR≤4.94)(45.6%、55.7%),差异均有统计学意义(PFS:P=0.009,OS:P=0.001);高PDW组(PDW>15.90)的5年PFS和OS(52.3%、66.5%)高于低PDW组(PDW≤15.90)(27.1%、32.5%),差异均有统计学意义(PFS:P=0.032,OS:P=0.039)。单因素分析结果显示:肿瘤切除程度(PFS:P=0.006,OS:P=0.009)、术后是否放疗(PFS:P=0.011,OS:P=0.001)是影响儿童髓母细胞瘤患者预后的影响因素。多因素生存分析示:术后未进行放疗(PFS:P=0.048,OS,P=0.008)、NLR>4.94(PFS:P=0.023,OS:P=0.003)及PDW≤15.90(PFS:P=0.028,OS:P=0.006)是影响儿童髓母细胞瘤患者预后的独立危险因素。结论随着NLR的升高和PDW的降低,儿童髓母细胞瘤患者的预后越差,NLR和PDW可能为儿童髓母细胞瘤患儿潜在的预后标志物。

Objective To investigate the effect of peripheral blood neutrophil to lymphocyte ratio(NLR)and platelet distribution width(PDW)on the clinical prognosis of childhood medulloblastoma Methods Clinical data and survival data of 76 pediatric patients who were diagnosed as medulloblastoma by post-operative pathology in the First Affiliated Hospital of Zhengzhou University from January 2009 to December 2016 were collected.Kaplan-Meier method was used to calculate the overall survival(OS)and progression free survival(EFS)rates,Log-rank test was employed to compare the survival rates of different groups,and Cox proportional hazards regression model was used for multivariate analysis.Results The log-rank test revealed that 5-year PFS rate and OS rate(22.2%,22.2%)in the high NLR group(NLR>4.94)were significantly lower than those in the low NLR group(NLR≤4.94)(45.6%,55.7%),and the differences were statistically significant(PFS:P=0.009,OS:P=0.001),and the 5-year PFS and OS(52.3%,66.5%)of the high PDW group(PDW>15.90)were significantly higher than those in the low PDW group(PDW≤15.90)(27.1%,32.5%),and the differences were statistically significant(PFS:P=0.032,OS:P=0.039).Univa-riate analysis showed that the extent of resection(PFS:P=0.006,OS:P=0.009),and postoperative radiotherapy(PFS:P=0.011,OS:P=0.001)and postoperative radiotherapy(PFS:P=0.011,OS:P=0.001)were the factors influencing the prognosis of children with medulloblastoma.Multivariate Cox proportional hazards regression model analysis suggested that no postoperative radiotherapy(PFS:P=0.048,OS:P=0.008),NLR>4.94(PFS:P=0.023,OS:P=0.003)and PDW≤15.90(PFS:P=0.028,OS:P=0.006)were the independent risk factors for the prognosis of childhood medulloblastoma.Conclusions Increased NLR and decreased PDW indicate unfavorable prognosis of the childhood medulloblastoma.Therefore,preoperative NLR and PDW may be the potential prognostic markers for childhood medulloblastoma.