术前平均血小板体积预测老年食管鳞癌患者术后生存情况的价值

Value of preoperative mean platelet volume in predicting postoperative survival in elderly patients with esophageal squamous cell carcinoma

目的:探讨术前平均血小板体积(MPV)预测老年食管鳞癌患者术后生存情况的价值。方法:纳入2014年1月-2016年12月在我院接受手术治疗的259例老年食管鳞癌患者作为研究对象,绘制术前MPV预测老年食管鳞癌患者术后生存情况的ROC曲线,获得术前MPV的最佳诊断截点,根据术前MPV的最佳诊断截点将所有患者分为两组,Logistic模型估计每个患者的倾向性评分,运用1∶1最近邻居倾向性匹配评分(PSM)法将两组中的倾向性评分最为相近的两个患者进行配对,比较匹配前后两组间各临床病理指标的均衡性,Kaplan-Meier生存分析比较匹配后两组患者术后无病生存率和总生存率,Cox回归模型进行敏感性分析,验证匹配后术前MPV对老年食管鳞癌术后生存情况的预测价值。结果:259例老年食管鳞癌患者术后1年、3年、5年无病生存率和总生存率分别为60.3%、41.9%、25.1%和86.1%、62.6%、43.2%,ROC分析结果显示,术前MVP预测老年食管鳞状细胞癌患者术后生存情况的AUC为0.835(95%CI:0.776~0.897),最佳诊断截点为12.7 fL,相应的灵敏度和特异度分别为83.6%和85.4%,根据术前MPV的最佳诊断截点,将所有患者分别分为MPV≥12.7 fL组112例(43.2%)和MPV<12.7 fL组147例(56.8%),采用1∶1最近邻居PSM法,结果两组共65对匹配成功,匹配后两组肿瘤直径、胸膜粘连、TNM/T分期、淋巴结转移、淋巴结转移数目、脉管癌栓6个指标比较均无明显差异,两组间各指标分布的均衡性得到了明显的提高(P>0.05),Kaplan-Meier生存分析显示,匹配后MPV≥12.7 fL组患者术后1年、3年、5年无病生存率明显低于MPV<12.7 fL组(51.6%、23.8%、18.5%vs 66.5%、48.8%、32.7%,χ^(2)/P=5.789/0.024),MPV≥12.7 fL组患者术后1年、3年、5年总生存率明显低于MPV<12.7 fL组(85.6%、51.8%、32.5%vs 92.5%、72.8%、51.7%,χ^(2)/P=5.674/0.026),Cox回归分析显示,老年食管鳞癌患者术前MVP每增加1 fL,患者术后5年内肿瘤复发转移的风险增加0.895倍,患者术后5年内死亡的风险增加1.016倍。结论:MPV作为活化血小板的评价指标可用于评估老年食管鳞癌患者术后的生存情况,并且具有较高的预测价值。

Objective:To investigate the value of preoperative mean platelet volume(MPV)in predicting postoperative survival of elderly patients with esophageal squamous cell carcinoma.Methods:259 elderly patients with esophageal squamous cell carcinoma who received surgical treatment in our hospital from January 2014 to December 2016 were included as study subjects.The ROC curve of preoperative MPV predicting the postoperative survival of elderly esophageal squamous cell carcinoma was drawn,and the best diagnostic cut-off point of preoperative MPV was obtained.All patients were divided into two groups according to the best diagnostic cut-off point of preoperative MPV.The propensity score of each patient was estimated by Logistic model,and the two patients with the most similar propensity score in the two groups were matched by 1∶1 propensity matching score(PSM),the balance of clinicopathological indexes of patients between the two groups were compared before and after matching.Kaplan Meier survival analysis was used to compared the postoperative disease-free survival rate and overall survival rate of elderly patients with esophageal squamous cell carcinoma between the two groups.Cox regression model was used for sensitivity analysis to verify the predictive value of matched preoperative MPV for postoperative survival of elderly esophageal squamous cell carcinoma.Results:The disease-free survival rate and overall survival rate of 259 elderly patients with esophageal squamous cell carcinoma were 60.3%,41.9%,25.1%and 86.1%,62.6%and 43.2%respectively.The ROC curve showed that the AUC of preoperative MVP predicting the postoperative survival of elderly patients with esophageal squamous cell carcinoma was 0.835(95%CI:0.776~0.897),and the best cut-off point for diagnosis was 12.7 fL.The corresponding sensitivity and specificity were 83.6%and 85.4%respectively.According to the optimal cut-off point of preoperative MPV,the patients were divided into 112 cases(43.2%)in the MPV≥12.7 fL group and 147 cases(56.8%)in the MPV<12.7 fL group respectively.The 1∶1 nearest neighbor PSM method was used.A total of 65 pairs of the two groups were successfully matched.After matching,there were no significant differences between the two groups in tumor diameter,pleural adhesion,TNM/T stage,lymph node metastasis,number of lymph node metastasis,and vascular tumor thrombus 6 indicators,the balance of the distribution of various indicators between the two groups was significantly improved(P>0.05).Kaplan Meier survival analysis showed that after matching,1-year,3-year and 5-year disease-free survival rate of patients in the MPV≥12.7 fL group was significantly lower in the MPV<12.7 fL group(51.6%,23.8%,18.5%vs 66.5%,48.8%,32.7%,χ^(2)/P=5.789/0.024),and the 1-year,3-year,and 5-year overall survival rates of patients in the MPV≥12.7 fL group were significantly lower than those in the MPV<12.7 fL group(85.6%,51.8%,32.5%vs 92.5%,72.8%,51.7%,χ^(2)/P=5.674/0.026).Cox regression analysis showed that for every 1 fL increase in preoperative MVP in elderly patients with esophageal squamous cell carcinoma,the risk of postoperative tumor recurrence and metastasis within 5 years increased by 0.895 times,and the risk of postoperative death within 5 years increased by 1.016 times.Conclusion:MPV as an evaluation index of activated platelets,can be used to evaluate the postoperative survival of elderly patients with esophageal squamous cell carcinoma,and has high predictive value.