凝血功能与老年放化疗食管癌患者预后的相关性

Predictive Value of Coagulation Function for Prognosis in Older Patients with Esophageal Cancer after Radiochemotherapy

目的分析凝血功能相关指标预测食管癌患者预后风险的临床价值。方法回顾性选取2016年6月~2020年12月哈尔滨医科大学附属第一医院放化疗的328例食管癌患者。根据末次随访时生存状况,分为存活组96例和死亡组232例。收集放化疗前凝血功能等临床资料,采用多因素Cox回归分析食管癌患者死亡的危险因素,并采用ROC曲线对凝血功能预测食管癌死亡的性能进行评定。结果两组年龄、治疗方式、TNM分期、放化疗前后体质量下降程度、下肢静脉血栓以及放化疗前C-反应蛋白(CRP)、纤维蛋白原(FIB)、凝血酶原时间(PT)、D-二聚体、老年营养风险指数(GNRI)比较,差异均具有统计学意义(P<0.05)。多因素Cox回归分析结果显示,TNM分期Ⅲ期、放化疗前后体质量下降≥5 kg、下肢静脉血栓、FIB≥2.65 g/L、PT≥11.26 s是食管癌患者死亡的独立危险因素(P<0.05),GNRI≥84.35是其保护因素(P<0.05)。ROC曲线分析显示,FIB预测食管癌患者死亡的曲线下面积最高(0.885),其次为PT(0.768)、GNRI最低(0.720)。结论凝血功能与放化疗食管癌预后关系密切,其中FIB、PT对其全因死亡风险具有较好的预测价值。

Objective To analyze the clinical value of coagulation function-related indices in predicting the prognostic risk in patients with esophageal cancer.Methods A retrospective analysis was conducted on 328 patients with esophageal cancer treated with radiochemotherapy in the First Affiliated Hospital of Harbin Medical University from June 2016 to December 2020.According to the survival status at the last follow-up,96 cases were assigned to the survival group and 232 cases to the death group.Clinical data such as coagulation function before radiochemotherapy were collected.Multivariate Cox regression was used to analyze the risk factors for death.Receiver operating characteristic(ROC)curve was used to assesse the performance of coagulation function in predicting death in patients with esophageal cancer.Results There were significant differences between the two groups in age,treatment modality,TNM stage,degree of weight loss after radiochemotherapy,lower limb venous thrombosis,levels of C-reactive protein and fibrinogen(FIB),prothrombin time(PT),level of D-dimer,and geriatric nutritional risk index(GNRI)before radiochemotherapy(P<0.05).Multivariate Cox regression analysis showed that TNM stageⅢ,weight loss≥5 kg after radiochemotherapy,lower limb venous thrombosis,FIB≥2.65 g/L,and PT≥11.26 s were independent risk factors for death in patients with esophageal cancer(P<0.05),and GNRI was a protective factor(P<0.05).ROC curve analysis showed that FIB predicted death in patients with oesophageal cancer with the highest area under the curve(0.885),followed by PT(0.768)and GNRI(0.720).Conclusion Coagulation function is closely related to the prognosis of esophageal cancer after radiochemotherapy.FIB and PT have significant predictive value for all-cause mortality risk in patients with esophageal cancer.