血红蛋白/红细胞分布宽度比值对局部晚期宫颈癌同步放化疗预后的预测价值

Prognostic value of hemoglobin/red blood cell distribution width ratio in patients with locally advanced cervical cancer receiving concurrent chemoradiotherapy

目的分析血红蛋白(Hb)/红细胞分布宽度(RDW)比值(HRR)对局部晚期宫颈癌同步放化疗预后的预测价值。方法选取2018年9月至2021年9月该院收治的216例同步放化疗局部晚期宫颈癌患者作为研究对象,随访24个月后根据患者生存情况分为生存组和死亡组。检测所有局部晚期宫颈癌患者同步放化疗前Hb、RDW,并计算HRR。采用受试者工作特征曲线分析HRR对局部晚期宫颈癌患者同步放化疗预后的预测价值。采用多因素Cox回归分析局部晚期宫颈癌患者同步放化疗预后的危险因素。结果216例局部晚期宫颈癌患者出院后连续随访24个月,182例患者存活,总生存率为84.26%。生存组Hb、HRR均高于死亡组,RDW低于死亡组,差异均有统计学意义(P<0.05)。Hb、RDW及HRR预测局部晚期宫颈癌患者同步放化疗预后的曲线下面积分别为0.741(95%CI:0.691~0.783)、0.825(95%CI:0.775~0.879)、0.912(95%CI:0.868~0.962)。不同年龄、产次、人乳头瘤病毒感染情况、国际妇产科联盟分期、肿瘤最大径、卡氏评分的局部晚期宫颈癌患者24个月总生存率比较,差异均无统计学意义(P>0.05)。肿瘤中/高分化程度、无盆腔淋巴结肿大、HRR>1.13的局部晚期宫颈癌患者24个月总生存率均高于肿瘤低分化程度、有盆腔淋巴结肿大、HRR≤1.13的患者,差异均有统计学意义(P<0.05)。多因素Cox回归分析结果显示,肿瘤低分化程度(HR=3.770,95%CI:1.745~8.144)、盆腔淋巴结肿大(HR=3.093,95%CI:1.466~6.526)、HRR≤1.13(HR=5.013,95%CI:2.079~12.086)是局部晚期宫颈癌患者同步放化疗预后的危险因素(P<0.05)。结论低水平HRR是局部晚期宫颈癌患者同步放化疗预后的危险因素,其对评估局部晚期宫颈癌患者同步放化疗的预后有一定预测价值。

Objective To analyze the prognostic value of hemoglobin(Hb)/red blood cell distribution width(RDW)ratio(HRR)in patients with locally advanced cervical cancer receiving concurrent chemoradiotherapy.Methods A total of 216 patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy in this hospital from September 2018 to September 2021 were selected as the research objects.After 24 months of follow-up,they were divided into survival group and death group according to the survival of the patients.Hb and RDW were detected in all patients with locally advanced cervical cancer before concurrent chemoradiotherapy,and HRR was calculated.The receiver operating characteristic curve was used to analyze the predictive value of HRR for the prognosis of patients with locally advanced cervical cancer receiving concurrent chemoradiotherapy.Multiariable Cox regression was used to analyze the risk factors for the prognosis of patients with locally advanced cervical cancer undergoing concurrent chemoradiotherapy.Results A total of 216 patients with locally advanced cervical cancer were followed up for 24 months after discharge,182 patients survived,and the overall survival rate was 84.26%.The Hb and HRR of the survival group were higher than those of the death group,and the RDW was lower than that of the death group,and the differences were statistically significant(P<0.05).The area under the curve of Hb,RDW and HRR for predicting the prognosis of patients with locally advanced cervical cancer undergoing concurrent chemoradiotherapy was 0.741(95%CI:0.691-0.783),0.825(95%CI:0.775-0.879)and 0.912(95%CI:0.868-0.962)respectively.There was no significant difference in the 24-month overall survival rate among patients with different ages,parity,human papillomavirus infection,International Federation of Gynecology and Obstetrics stage,tumor size,and Karnofsky score(P>0.05).The 24-month overall survival rate of patients with locally advanced cervical cancer with moderate/high tumor differentiation,no pelvic lymph node enlargement and HRR>1.13 was higher than that of patients with low tumor differentiation,pelvic lymph node enlargement and HRR≤1.13,and the differences were statistically significant(P<0.05).Multivariate Cox regression analysis showed that poor tumor differentiation(HR=3.770,95%CI:1.745-8.144),pelvic lymphadenopathy(HR=3.093,95%CI:1.466-6.526),HRR≤1.13(HR=5.013,95%CI:2.079-12.086)were risk factors for the prognosis of patients with locally advanced cervical cancer after concurrent chemoradiotherapy(P<0.05).Conclusion Low HRR is a risk factor for the prognosis of patients with locally advanced cervical cancer undergoing concurrent chemoradiotherapy,and it has certain predictive value for the prognosis of patients with locally advanced cervical cancer undergoing concurrent chemoradiotherapy.