血小板和淋巴细胞比值联合CA19-9在胆囊癌术后患者预后评估中的价值

Evaluation value of platelet-to-lymphocyte ratio combined with CA19-9 for postoperative prognosis of patients with gallbladder cancer

目的:探讨术前血小板和淋巴细胞比值(PLR)联合CA19-9在胆囊癌患者术后预后评估中的价值。方法:回顾性分析2015年12月至2020年12月华中科技大学同济医学院附属同济医院收治的67例胆囊癌术后患者临床资料。其中男28例,女39例;平均年龄(58±10)岁。患者均签署知情同意书,符合医学伦理学规定。生存分析采用Kaplan-Meier法和Log-rank检验;Cox多因素回归分析影响胆囊癌患者术后预后的独立危险因素;采用ROC曲线下面积(AUC)分析PLR +CA19-9预测胆囊癌患者术后预后的能力。结果:PLR、CA19-9、PLR + CA19-9对胆囊癌患者术后3年总体生存期(OS)预测的ROC曲线分析显示,最佳界值分别为162、38、0.65。Cox多因素回归分析显示,PLR≥162和CA19-9≥38 kU/L是胆囊癌患者术后预后的独立危险因素(HR=3.093,3.852;P<0.05)。低水平和高水平PLR + CA19-9组中位OS分别为43、15个月,差异有统计学意义(χ^(2)=44.342,P<0.05)。PLR预测胆囊癌患者术后1、3年无进展生存期的AUC分别为0.741、0.777,CA19-9相应为0.838、0.780,PLR + CA19-9相应为0.901、0.882。结论:术前PLR联合CA19-9在胆囊癌患者术后预后评估中的预测价值大于PLR或CA19-9单独评估,有一定的临床应用价值。

Objective To evaluate the value of preoperative platelet-to-lymphocyte ratio(PLR)combined with CA19-9 in evaluating postoperative prognosis of patients with gallbladder cancer.Methods Clinical data of 67 patients with gallbladder cancer admitted to Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from December 2015 to December 2020 were retrospectively analyzed.Among them,28 patients were male and 39 female,aged(58±10)years on average.The informed consents of all patients were obtained and the local ethical committee approval was received.Survival analysis was performed by Kaplan-Meier method and Log-rank test.The independent risk factors of postoperative prognosis of patients with gallbladder cancer were identified by multivariate Cox regression analysis.The efficiency of PLR+CA19-9 for predicting postoperative prognosis of patients with gallbladder cancer was assessed by delineating the area under ROC curve(AUC).Results ROC curve analysis showed that the optimal thresholds of PLR,CA19-9 and PLR+CA19-9 for predicting 3-year overall survival(OS)of patients with gallbladder cancer were 162,38 and 0.65,respectively.Multivariate Cox regression analysis indicated that PLR≥162 and CA19-9≥38 kU/L were the independent risk factors for postoperative prognosis of patients with gallbladder cancer(HR=3.093,3.852;P<0.05).The median OS in the low and high PLR+CA19-9 groups was 43 and 15 months,and the difference was statistically significant(χ^(2)=44.342,P<0.05).The AUC of PLR in predicting postoperative 1-and 3-year progression-free survival of patients with gallbladder cancer was 0.741 and 0.777,0.838 and 0.780 for CA19-9,and 0.901 and 0.882 for PLR+CA19-9,respectively.Conclusions Preoperative PLR combined with CA19-9 has higher value in predicting postoperative prognosis of patients with gallbladder cancer compared with PLR or CA19-9alone,which is of certain value in clinical application.