甲状腺髓样癌患者术前血小板分布宽度与临床病理特征及预后的关系

Association of preoperative platelet distribution width with clinicopathologic features and prognosis of medullary thyroid carcinoma patients

目的按探讨术前血小板分布宽度(plateletdistributionwidth,PDW)与甲状腺髓样癌(medullary thyroid carcinoma,MTC)患者临床病理特征及预后的关系。方法回顾性收集浙江省肿瘤医院头颈外科2007年6月至2021年9月收治的160例MTC患者的临床资料,男74例,女86例,年龄(48.73±13.76)岁,范围8~77岁。根据中位数确定PDW临界值,分为低PDW组和高PDW组。采用x^(2)检验和Spearman相关性检验分析术前PDW与MTC临床病理特征的相关性,采用Kaplan-Meier法绘制生存曲线,Log-rank检验比较不同术前PDW水平患者总生存期(overall survival,OS)和无病生存期(disease free survival,DFS)的差异,进一步单因素和多因素Cox回归分析影响MTC患者DFS的危险因素。结果术前PDW水平与MTC患者的肿块大小(x^(2)=4.46,P=0.035)、TNM分期(x^(2)=5.02,P=0.025)、双侧病灶(x^(2)=4.94,P=0.026)、多发病灶(x^(2)=5.19,P=0.023)、被膜侵犯(x^(2)=5.75,P=0.017)、腺外侵犯(^(2)=4.27,P=0.039)、脉管瘤栓(x^(2)=4.48,P=0.034)密切相关。Spearman相关性检验发现术前PDW水平与MTC患者的临床分期(r=-0.166,P=0.036)、淋巴结转移(r=-0.187,P=0.018)、多发病灶(r=-0.176,P=0.026)和脉管瘤栓(r=-0.220,P=0.005)均呈负相关。生存分析显示,降低的PDW预示着MTC患者更差的DFS(X=9.989,P=0.002)。多因素Cox回归分析显示,低PDW(OR=0.847,95%CI:0.724~0.992,P=0.040)和淋巴结转移(0R=4.913,95%CI:2.415~9.995,P<0.001)是影响MTC患者DFS的独立危险因素。结论术前降低的PDW是MTC预后不良的高危因素,可作为MTC患者预测复发的指标。

Objective To investigate the correlation of preoperative platelet distribution width(PDW)with clinical features and prognosis of patients with medullary thyroid carcinoma(MTC).Methods The clinical data of 160 MTC patients admitted to Zhejiang Cancer Hospital in Department of Head and Neck Surgery from Jun.2007 to Sep.2021 were retrospectively collected.There were 74 males and 86 females,aging 8-77 years(mean 48.73±13.76).The median was used to determine the cut-offvalue of PDW and divided into low PDW group and high PDW group.The correlation between preoperative PDW and clinicopathological features of MTC patients was analyzed by Chi-square test and Spearman correlation test.The relationship of preoperative PDW with overall sur-vival(OS)and disease free survival(DFS)of patients were analyzed by Kaplan-meier and Log-rank test.Univari-ate and multivariate Cox regression analyses were used to analyze the risk factors for DFS in MTC patients.Results The preoperative PDW level was closely correlated with the tumor size(x^(2)=4.46,P=0.035),TNM stage(x^(2)=5.02,P=0.025),bilateral lesions(=4.94,P=0.026),multiple lesions(x^(2)=5.19,P=0.023),capsular invasion(=5.75,P=0.017),extrandular invasion(x^(2)=4.27,P=0.039),and vascular tumor thrombus(x^(2)=4.48,P=0.034)in MTC patients(P<0.05).Spearman correlation test showed that preoperative PDW level was negatively correlated with clinical stage(r=-0.166,P=0.036),lymph node metastasis(r=-0.187,P=0.018),multiple lesions(r=-0.176,P=0.026)and vascular tumor thrombus(r=-0.220,P=0.005)in MTC patients(P<0.05).Survival analysis showed that reduced PDW predicted worse DFS for MTC(x^(2)=9.989,P=0.002).Multivariate Cox regression analysis showed that low PDW(OR=0.847,95%CI:0.724-0.992,P=0.040)and lymph node metastasis(OR=4.913,95%CI:2.415-9.995,P<0.001)were independent risk factors for DFS in MTC patients.Conclusion Preoperative decreased PDW is a high risk factor for poor prognosis of MTC and can be used as an indicator to predict recurrence in MTC patients.