胃癌患者根治性手术后血小板分布宽度与远期生存的相关性

Correlation between platelet distribution width and long-term survival in patients with gastric cancer after radical surgery

背景胃癌是一种常见的消化系统肿瘤,以手术为首选治疗方式,但患者术后远期生存仍不理想.据研究表明,血小板分布宽度(platelet distribution width,PDW)在肿瘤发生发展中占据重要角色.本研究拟分析血清PDW与Ⅱ-ⅢA期胃癌患者根治术后远期生存的相关性.目的观察Ⅱ-ⅢA期胃癌患者根治手术后血清PDW与远期生存的关系.方法本研究采用前瞻性队列研究方法,纳入医院2016-01/2017-12接受手术治疗的124例胃癌患者作为研究对象.全部患者均于术后检测PDW水平,接受为期5年的随访并记录生存时间.根据患者术后PDW是否升高分为PDW降低组、PDW正常组和PDW升高组,比较不同组别的患者临床病理特征和远期生存情况.采用点二列相关性、COX回归检验术后PDW与患者远期生存的相关性和对远期生存的影响,绘制受试者工作特征(receiver operating characteristic curve,ROC)曲线分析术后PDW预测远期生存的价值.结果胃癌患者治疗后的CEA、CA199和PDW水平均低于治疗前,差异有统计学意义(P<0.05).111例胃癌患者中,有35例PDW降低,24例处于正常范围,52例PDW升高,分别占31.53%、21.62%和46.85%.PDW升高组恶性肿瘤国际临床病理分期(tumor lymph node metastasis,TNM)分期(-ⅢA期)、淋巴结转移占比高于PDW正常组、PDW降低组,差异有统计学意义(P<0.05);但三组间患者年龄、性别、分化程度、肿瘤直径、肌层浸润深度比较、PDW降低组与PDW正常组患者年龄、性别、分化程度、肿瘤直径、肌层浸润深度、TNM分期和淋巴结转移比较,差异均无统计学意义.111例胃癌中,生存31例,生存率为27.93%,生存时间(11-60)mo,中位生存时间43.00(31.00,60.00)mo.经点二列相关性检验,胃癌患者根治性手术后PDW、淋巴结转移和TNM分期均与远期生存呈正相关性(r>0,P<0.05).COX回归分析,在调整TNM分期、淋巴结转移后,以PDW正常组为参照,PDW升高是胃癌患者远期生存的危险因素.PDW降低组患者中位生存时间为49.50(33.00,60.00)mo,PDW正常组患者中位生存时间为53.50(49.25,58.00)mo,PDW升高组患者中位生存时间为29.00(20.00,35.00)mo,三组间生存时间比较,差异有统计学意义(P<0.05).ROC曲线显示,术后PDW水平预测胃癌患者远期生存具有一定的预测价值(AUC=0.718,95%CI:0.614-0.822,P<0.001).结论胃癌根治性手术后PDW与患者远期生存情况有关系,当PDW水平升高提示胃癌患者远期预后不良、生存期短,且TNM分期、淋巴结转移也与胃癌患者远期生存有密切联系.

BACKGROUND Gastric cancer is a common digestive system tumor,and surgery is the first choice of treatment,but the long-term survival of patients after surgery is still not satisfactory.Previous studies have showed that platelet distribution width(PDW)plays an important role in the occurrence and development of tumor.This study aimed to analyze the correlation between PDW and long-term survival of patients with stageⅡ-ⅢA gastric cancer after radical surgery.AIM To explore the relationship between PDW and long-term survival in patients with stageⅡ-ⅢA gastric cancer after radical surgery.METHODS This is a prospective cohort study,in which 124 patients with gastric cancer who received surgical treatment at our hospital from January 2016 to December 2017 were included as the study subjects.All patients were followed for 5 years and their survival time was recorded.The patients were divided into three groups according to whether their PDW increased or not after surgery:PDW decrease group,PDW normal group,and PDW increase group.The clinicopathological characteristics and long-term survival of patients in different groups were compared.Point binary correlation and COX regression were used to test the correlation between postoperative PDW and long-term survival of patients and the impact of PDW on long-term survival.Receiver operating characteristic(ROC)curve analysis was performed to analyze the value of postoperative PDW in predicting long-term survival.RESULTS The levels of CEA,CA199,and PDW in gastric cancer patients after treatment were significantly lower than those before treatment(P<0.05).Among 111 patients with gastric cancer,35(31.53%)had decreased PDW,24(21.62%)had normal PDW,and 52(46.85%)had increased PDW.The rates of lymph node metastasis and advanced tumor-node-metastasis(TNM)stage(ⅢA)in the PDW increase group were significantly higher than those of the PDW normal group and PDW decrease group(P<0.05).However,there were no statistical significant differences among the three groups in terms of age,sex,degree of differentiation,tumor diameter,depth of muscle invasion,TNM stage,and lymph node metastasis(P>0.05).Among 111 cases of gastric cancer,31 survived,with a survival rate of 27.93%;the survival time was 11-60 mo,and the median survival time was 43.00(31.00,60.00)mo.Point binary correlation test showed that PDW,lymph node metastasis,and TNM stage were positively correlated with long-term survival after radical surgery(r>0,P<0.05).COX regression analysis showed that after adjusting for TNM stage and lymph node metastasis,taking the normal PDW group as a reference,the increase of PDW was a risk factor for long-term survival of gastric cancer patients.The median survival time of the patients with decreased,normal,and increased PDW was 49.50(33.00,60.00)mo,53.50(49.25,58.00)mo,and 29.00(20.00,35.00)mo,respectively,and the difference among the three groups was statistically significant(P<0.05).ROC curve analysis showed that postoperative PDW level had appreciated value in predicting long-term survival of gastric cancer patients(AUC=0.718,95%CI:0.614-0.822,P<0.001).CONCLUSION PDW is related to the long-term survival of patients with gastric cancer after radical surgery.Increased PDW indicates that the long-term prognosis of gastric cancer patients is poor and the survival period is short.TNM stage and lymph node metastasis are also closely related to the long-term survival of gastric cancer patients.