术前血小板分布宽度和肿瘤大小比值在非转移性肺腺癌患者预后中的价值

The value of the ratio of pre⁃operative platelet distribution width to tumor size in the prognosis of patients with non⁃metastatic lung adenocarcinoma

目的探讨术前血小板分布宽度(platelet distribution width,PDW)与肿瘤大小(tumor size,TS)比值(PDW to TS ratio,PdwTR)在非转移性肺腺癌患者无病生存期(disease-free survival,DFS)中的预测价值。方法收集解放军总医院海南医院自2012年12月至2020年12月经手术治疗后病理确诊的非转移性肺腺癌患者198例。根据受试者工作特征(ROC)曲线确定PdwTR的最佳截断值,并根据截断值将患者分为PdwTR低组和PdwTR高组,采用时间依赖的ROC曲线评估PdwTR、PDW、TS预测DFS的效能,Cox比例风险模型分析PdwTR与DFS的关联。结果PdwTR最佳截点值为7.45,其预测3年DFS的敏感性为93.90%,特异性为61.20%,ROC曲线下面积(AUC)为0.83(95%CI:0.75~0.90)。Log-rank检验结果显示,PdwTR低组的DFS低于PdwTR高组(log-rankχ^(2)=28.99,P<0.001);Cox回归模型调整年龄、性别、BMI、CEA水平、T分期、N分期、TNM分期、NLR、LMR和PNI等潜在混杂因素后,PdwTR高组的复发风险较PdwTR低组下降93.0%(HR=0.07,95%CI:0.02~0.33,P=0.001)。结论术前PdwTR低与非转移性肺腺癌患者DFS较差独立相关,可作为DFS的预测指标。

Objective To investigate the predictive value of pre⁃operative platelet distribution width(PDW)to tumor size(TS)ratio(PdwTR)on the disease⁃free survival(DFS)in non⁃metastatic lung adenocarcinoma patients.Methods A total of 198 patients of non⁃metastatic lung adenocarcinoma diagnosed pathologically after surgical treatment were collected in Hainan Hospital of PLA General Hospital from December 2012 to December 2020.The patients were divided into low PdwTR group and high PdwTR group,according to the optimal cut⁃off value of PdwTR determined by receiver operating characteristic(ROC)curve.The effectiveness of PdwTR,PDW and TS in predicting DFS was evaluated by time⁃dependent ROC curve,and the association between PdwTR and DFS was analyzed by Cox proportional hazard model.Results The optimal cut⁃off point of PdwTR was 7.45,the sensitivity and specificity of PdwTR for 3⁃year DFS were 93.90%and 61.20%,respectively.In addition,the area under ROC curve for PdwTR was 0.83(95%CI:0.75-0.90).The results of log⁃rank test showed that the DFS of low PdwTR group was lower than that of high PdwTR group(log⁃rankχ^(2)=28.99,P<0.001).After the adjustment for potential confounding factors such as age,gender,BMI,CEA level,T stage,N stage,TNM stage,NLR,LMR,and PNI by Cox regression model,the high PdwTR group showed a 93.0%decrease in the risk of recurrence compared to the low PdwTR group(HR=0.07,95%CI:0.02-0.33,P=0.001).Conclusions Low preoperative PdwTR is independently associated with poor DFS in patients with non⁃metastatic lung adenocarcinoma,and can be used as a predictor of DFS.