纤维蛋白原在局部晚期头颈部鳞癌诱导化疗联合放疗中的临床意义和预后价值

Clinical significance and prognostic value of fibrinogen in the treatment of locally advanced head and neck squamous cell carcinoma treated with induction chemotherapy combined with radiotherapy

目的探讨纤维蛋白原(FIB)在局部晚期头颈部鳞癌诱导化疗联合根治性放疗中的临床意义及预后价值。方法回顾性分析2011年5月至2021年5月贵州医科大学附属肿瘤医院头颈肿瘤科收治的114例局部晚期头颈部鳞癌非手术治疗患者的临床资料, 根据诱导化疗前FIB水平的中位数确定FIB临界值, 从而分为高FIB组与低FIB组, 受试者工作特征(ROC)曲线确定中性粒细胞、淋巴细胞、血小板等其他血液学相关参数的最佳临界值。计数资料的比较用χ2检验或Fisher确切概率法, OS和PFS用Kalplan-Meier法绘制生存曲线, 并Log-rank法检验, Cox比例风险回归模型评估预后因素。结果高FIB组患者59例(FIB>3.6 g/L),低FIB组患者55例(FIB≤3.6 g/L)。高FIB组患者较低FIB组患者有更高的中性粒细胞、血小板、NLR及PLR(χ^(2)= 7.84、12.80、15.04、9.14, P<0.05)。低FIB组患者的3、5年总生存率(OS)优于高FIB组患者(62.9%vs. 39.6%;46.9%vs. 25.8%), 低FIB组患者的3、5年无进展生存率(PFS)优于高FIB组患者(63.3%vs. 40.3%;48.1%vs. 26.2%)。单因素分析结果显示FIB、是否同步放化疗、放疗后淋巴结疗效与局部晚期头颈部鳞癌患者OS和PFS相关, 多因素分析结果显示FIB、是否同步放化疗、放疗后淋巴结疗效是局部晚期头颈部鳞状细胞癌患者OS[HR(95%CI):1.89(1.08~3.31)、3.76(1.12~12.65)、2.14(1.09~4.21), P<0.05]和PFS的独立预后因素[HR(95%CI):1.92(1.90~3.36)、3.93(1.01~11.34)、2.15(1.09~4.22),P<0.05]。结论低FIB的局部晚期头颈部鳞癌患者, 诱导化疗联合放疗治疗后OS率与PFS率更高。FIB可能作为评估局部晚期头颈部鳞癌患者非手术治疗的一个预后因素指标。

Objective To explore the clinical significance and prognostic value of fibrinogen(FIB)in the treatment of locally advanced head and neck squamous cell carcinoma with induction chemotherapy combined with radiotherapy.Methods A retrospective analysis was conducted for the clinical data of 114 patients with locally advanced head and neck squamous cell carcinoma receiving non-surgical treatment in the Department of Head and Neck Oncology,the Affiliated Cancer Hospital of Guizhou Medical University from May 2011 to May 2021.The FIB critical value was determined based on the median FIB level before induction chemotherapy,by which patients were divided into high-FIB and low-FIB groups.The ROC curves were used to determine the optimal cut-off value for other hematologic-related parameters such as neutrophils,lymphocytes,and platelets.Statistical methods were used to analyze the results.The enumeration data were analyzed by Chi-square test or Fisher exact probability method.Survival curves for OS and PFS were plotted by Kalplan-Meier method and tested by Log-rank method.Prognostic factors were evaluated by Cox proportional hazard regression model.Results There were 59 cases in the high-FIB group(FIB>3.6 g/L)and 55 cases in the low-FIB group(FIB≤3.6g/L).The high FIB group had higher neutrophils,platelets,NLR,and PLR(χ^(2)=7.84,12.80,15.04,9.14;P<0.05)than the low FIB group.The 3-and 5-year overall survival(OS)rates were significantly longer in the low FIB group than those in the high-FIB group(62.9%vs.39.6%;46.9%vs.25.8%),and progression-free survival(PFS)rates of the low FIB group significantly longer than those of the high-FIB group(63.3%vs.40.3%;48.1%vs.26.2%).The univariate analysis showed that the OS and PFS in patients with locally advanced head and neck squamous cell carcinoma were related to FIB,the application of concurrent chemoradiotherapy,and the efficacy of radiotherapy for lymph nodes.The multivariate analysis showed that FIB,the application of concurrent chemoradiotherapy,and the efficacy of radiotherapy for lymph nodes were independent prognostic factors of the OS[HR(95%CI):1.89(1.08-3.31),3.76(1.12-12.65),2.14(1.09-4.21),P<0.05]and PFS HR(95%CI):1.92(1.90-3.36),3.93(1.01-11.34),2.15(1.09-4.22),P<0.05]of patients with locally advanced head and neck squamous cell carcinoma.Conclusions Patients with low FIB receive high OS and PFS rates after induction chemotherapy combined with radiotherapy.Therefore,FIB can be used as a prognostic factor in the evaluation of non-surgical treatment of patients with locally advanced head and neck squamous cell carcinoma.