术前红细胞分布宽度联合乳酸脱氢酶对结直肠癌肝转移术后患者预后的预测价值

Prognostic value of red cell distribution width combined with lactate dehydrogenase in patients with colorectal liver metastases

目的探讨术前红细胞分布宽度(red cell distribution width,RDW)、乳酸脱氢酶(lactate dehydrogenase,LDH)对结直肠癌肝转移(colorectal liver metastases,CLM)术后患者预后的预测价值。方法回顾性分析2016年1月-2017年10月于解放军总医院第一医学中心诊断为同时性结直肠癌肝转移并行同期根治性切除术的患者34例,收集术前1周内的RDW、LDH及其他相关临床、病理等资料,并对患者进行为期两年的随访。根据生存结局,将患者分为生存组(n=12)和死亡组(n=22),通过Cox比例风险模型分析结直肠癌肝转移术后患者预后的独立影响因素。根据ROC曲线计算所得的最佳临界值进一步将CLM患者分为低风险组(n=26)及高风险组(n=8),绘制Kaplan-Meier曲线比较两组患者术后两年的总生存期(overall survival,OS)。结果死亡组患者的RDW(16.22±5.10 vs 12.93±1.04,P=0.036)和LDH(194.23±36.90 vs 166.17±30.79,P=0.032)显著高于生存组,两组性别、年龄、体质量指数、术前血红蛋白、术前中性粒细胞计数、术前淋巴细胞计数、术前血清白蛋白、肿瘤直径、癌胚抗原及CA199均无统计学差异(P>0.05)。多因素分析显示LDH(HR=3.064,95%CI:1.179~7.961,P=0.022)、RDW(HR=2.372,95%CI:1.004~5.600,P=0.049)是影响CLM行同期手术患者预后的独立影响因素。ROC曲线分析显示RDW联合LDH预测CLM的曲线下面积为0.814,高于RDW的0.750(截断值13.7%)和LDH的0.742(截断值185 U/L)。以RDW≥13.7%且LDH≥185 U/L为高风险,其余为低风险进行分组,高风险组与低风险组术后两年的中位生存期分别为8个月(95%CI:2.5~13.5)及16个月(95%CI:9.8~22.2),差异有统计学意义(P=0.032)。结论RDW与LDH联合使用对CLM行同期根治性手术患者的预后具有良好的预测价值。

Objective To investigate the prognostic value of red cell distribution width(RDW)plus lactate dehydrogenase(LDH)in patients with colorectal liver metastases(CLM).Methods Clinical data about 34 patients diagnosed with synchronous colorectal cancer liver metastases and underwent simultaneous radical resection surgery in the First Medical Center of Chinese PLA General Hospital from January 2016 to October 2017 were retrospectively analyzed.RDW,LDH within a week before surgery,relevant clinical data and pathology results were collected.Patients with CLM were followed up for two years.Patients were divided into survival group and death group according to their survival outcomes within two years.Cox proportional hazards model was used to analyze the independent influencing factors.CLM patients were further divided into low-risk group(n=26)and high-risk group(n=8)according to the thresholds calculated by ROC curves.Kaplan-Meier curves were drawn to compare the overall survival(OS)between the high-risk group and the low-risk group within two years after surgery.Results The RDW(16.22±5.10 vs 12.93±1.04,P=0.036)and LDH(16.22±5.10 vs 12.93±1.04,P=0.036)in the death group were significantly higher than those in the survival group.There was no statistically significant difference in gender,age,BMI,preoperative hemoglobin,preoperative neutrophil count,preoperative lymphocyte count,preoperative serum albumin,tumor diameter,CEA and CA199(all P>0.05).Multivariate analysis showed that LDH 215 U/L(HR=3.064,95%CI:1.179-7.961,P=0.022)and RDW 14.5%(HR=2.372,95%CI:1.004-5.600,P=0.049)were independent indicators affecting the prognosis of patients with CLM undergoing simultaneous radical surgery.ROC curve analysis revealed that the AUC of RDW+LDH(0.814)was higher than that of RDW(0.750)and LDH(0.748),with the cut-off value of 13.7%for RDW and 185 U/L for LDH.The median survival time of the high-risk patients(RDW≥13.7%+LDH≥185 U/L)was 8 months(95%CI:2.5-13.5)compared with 16 months(95%CI:9.8-22.2)in the low-risk patients(RDW<13.7%or LDH<185 U/L),with significant difference(P=0.032).Conclusion RDW≥13.7%+LDH≥185 U/L has good predictive value for the prognosis of patients with CLM undergoing simultaneous radical surgery.