术前红细胞分布宽度与血小板比值对RP术后接受内分泌治疗患者预后的预测价值

The prognostic value of preoperative red cell distribution width to platelet ratio on prostate cancer patients treated with endocrine therapy after radical prostatectomy

目的:探讨术前红细胞分布宽度与血小板比值(RPR)对根治性前列腺切除术(RP)后接受内分泌治疗的前列腺癌患者预后的预测价值。方法:回顾性分析2007年10月至2018年10月天津医科大学第二医院收治的349例前列腺癌患者的临床资料。平均年龄67(42~84)岁。术前初诊总前列腺特异性抗原(tPSA)平均30.6(4.2~499.2)ng/ml。血清前列腺特异性抗原密度(PSAD)≥1.15 ng/(ml·cm 3)54例,<1.15 ng/(ml·cm 3)295例。所有患者均行RP。术后病理Gleason评分≥8分158例,<8分191例;病理分期≤T 2b期151例,T 2c期110例,≥T 3a期88例;切缘阳性114例,阴性235例;精囊侵犯86例。前列腺癌危险分度低危121例,中危83例,高危145例。349例术后接受雄激素剥夺治疗(ADT)。观察终点为患者无生化复发生存期(RFS)。根据受试者工作特征(ROC)曲线分析确定术前RPR最佳截断值,并据此将患者分为高RPR组和低RPR组,比较两组患者的临床资料。采用Kaplan-Meier法绘制生存曲线,采用单因素和多因素Cox回归分析术前RPR对患者预后的预测价值。结果:本组349例术后中位随访32(4~132)个月。93例出现生化复发。根据ROC曲线得出术前RPR的截断值为0.27(95%CI 0.502~0.653,P<0.05),将患者分为高RPR组(RPR≥0.27)和低RPR组(RPR<0.27)。高RPR组66例(18.9%),低RPR组283例(81.1%)。两组的Gleason评分(P=0.005)、初诊血清tPSA(P=0.000)、病理T分期(P=0.031)、前列腺癌危险分度(P=0.037)、切缘阳性(P=0.030)的差异有统计学意义。Kaplan-Meier生存分析结果显示,高RPR组RFS显著低于低RPR组(26.0个月与35.0个月,P<0.001)。单因素分析结果显示,患者Gleason评分(HR=1.579,95%CI 1.049~2.376,P=0.028)、初诊血清tPSA(HR=2.979,95%CI 1.655~5.362,P=0.000)、病理T分期(HR=1.292,95%CI 1.009~1.653,P=0.042)、术前RPR(HR=3.555,95%CI 2.339~5.401,P=0.000)是RP术后接受内分泌治疗患者预后的影响因素,年龄、PSAD、精囊侵犯、前列腺癌危险分度和切缘阳性不是预后的影响因素(均P>0.05)。多因素分析结果显示,初诊tPSA(HR=1.917,95%CI 1.033~3.558,P=0.039)和RPR(HR=3.086,95%CI 1.994~4.775,P=0.000)是RP术后接受内分泌治疗患者RFS的独立预测因素(均P<0.05)。结论:术前RPR可作为评估RP术后接受内分泌治疗患者预后的独立预测因素,术前RPR≥0.27的前列腺癌患者预后不良。

Objective To evaluate the prognostic value of preoperative red cell distribution width to platelet ratio on prostate cancer patients treated with endocrine therapy after radical prostatectomy.Methods The clinical data of 349 prostate cancer patients treated with endocrine therapy after radical prostatectomy in our hospital from October 2007 to October 2018 were retrospectively analyzed.Among all the patients,the average age was 67 years old(ranged 42 to 84 years).The preoperative newly diagnosed PSA level was 4.2-499.2 ng/ml(average 30.6 ng/ml).158 cases had a Gleason score of more than 8.191 cases had a Gleason score of below than 8.According to tumorous staging,151 patients were staged less than or equal to stage T2b,110 patients were staged as stage T2c,88 patients were staged equal or greater than stage T3a.295 patients were staged less than 1.15 ng/(ml·cm3)of prostate specific antigen density,54 patients were staged equal or greater than 1.15 ng/(ml·cm3).There were 86 cases of seminal vesicle invasion and 263 cases of non-seminal vesicle invasion.There were 121 patients with low risk of prostate cancer,83 patients with medium risk,and 145 patients with high risk.All patients received endocrine therapy after radical prostatectomy with androgen deprivation therapy(ADT).End point of observation was biochemical recurrence-free survival(RFS)with PCa patients treated with endocrine therapy after radical prostatectomy.Patients were categorized in two groups with high RPR and low RPR values using a cut-off point as calculated by the receiver-operating curve analysis.Correlations between RPR and clinical characteristics were analyzed.The prognostic analysis of preoperative RPR on prostate cancer patients treated with endocrine therapy after radical prostatectomy was estimated using Kaplan-Meier analysis and Cox proportional hazards models.Kaplan-Meier method was used to draw the survival curve.Meanwhile,univariate and multivariate Cox regression were used to explore factors influencing the prognosis of PCa patients.Results of the 349 cases,ranging 4-132 months.Biochemical recurrence with PCa patients occurred in 93 cases,and 256 patients were not biochemical recurrence.The ideal cutoff value of preoperative RPR was 0.27(95%CI 0.502-0.653,P<0.05)determined by the ROC curve,by which the 349 patients was divided into the high RPR group of 66 patients(18.9%)and the low RPR group of 283 patients(81.1%).Preoperative RPR was significantly associated with Gleason score(P=0.005),newly diagnosed tPSA value(P=0.000),tumor T stage(P=0.031),PCa risk scale(P=0.037),positive margin(P=0.030).The RFS in the high RPR group(26.0 months)was shorter than that in the low RPR group(35.0 months)(P<0.001).In univariate analysis,Gleason score(HR=1.579,95%CI 1.049-2.376,P=0.028),serum newly diagnosed tPSA(HR=2.979,95%CI 1.655-5.362,P=0.000),tumor T stage(HR=1.292,95%CI 1.009-1.653,P=0.042),preoperative RPR value(HR=3.555,95%CI 2.339-5.401,P=0.000)were prognostic factors(P<0.05).Cox multivariate analysis showed that higher newly diagnosed tPSA value(HR=1.917,95%CI 1.033-3.558,P=0.039)and higher RPR value(HR=3.086,95%CI 1.994-4.775,P=0.000)were independent predictors for endocrine therapy after radical prostatectomy of PCa(P<0.05).Conclusions Preoperative RPR was an independent predictor for poor prognosis in PCa patients treated with endocrine therapy after radical prostatectomy.