术前D-二聚体、血小板/淋巴细胞比值对乳腺癌临床诊断及预后的预测价值

Predictive values of preoperative D-dimer and platelet to lymphocyte ratio for clinical diagnosis and prognosis of breast cancer

目的探讨D-二聚体、血小板/淋巴细胞比值(PLR)与乳腺癌患者临床特征及预后的关系。方法回顾性分析2018年9月至2020年3月于南京医科大学第一附属医院住院治疗的乳腺癌患者67例,选取同期体检健康者30例作为健康人对照组,检测两组血浆D-二聚体、血小板(PLT)及淋巴细胞(L)数值,并计算PLR。分析D-二聚体、PLR水平与乳腺癌患者临床特征及预后之间的关系。结果乳腺癌组术前D-二聚体[1.13(0.62,2.18)mg/L]、PLR[135.2(106.6,166.5)]水平显著高于健康人对照组[D-二聚体:0.35(0.16,0.59)mg/L,PLR:102.9(88.4,115.8),P均<0.001]。术后复发组的术前D-二聚体[1.39(0.78,2.33)mg/L、PLR152.2(118.0,169.3)]水平显著高于术后未复发组[D-二聚体:0.35(0.16,0.59)mg/L,PLR:102.9(88.4,115.8),P均<0.001]。D-二聚体用于乳腺癌筛查及区分乳腺癌复发的ROC下面积(AUC^(ROC))分别为0.891、0.724,PLR的AUC^(ROC)分别为0.735、0.689,二者联合的AUC^(ROC)分别为0.907、0.762。D-二聚体与乳腺癌淋巴结转移(P=0.02)、远处转移(P=0.03)显著相关,而PLR与淋巴结转移显著相关(P<0.001)。二者联合高值组的无病生存率(DFS)显著低于低值组(中位生存时间:24.8个月vs 30.5个月,P=0.048)。结论术前D-二聚体、PLR水平与乳腺癌的淋巴转移及远处转移显著相关,且可以预测乳腺癌患者的预后。

Objective To investigate the relationship between D-dimer and platelet to lymphocyte ratio(PLR)and prognosis of breast cancer(BC).Methods The clinical data of 67 BC patients hospitalized in the First Affiliated Hospital of Nanjing Medical University from September 2018 to March 2020 were retrospectively analyzed.Thirty healthy individuals during the same period were enrolled as controls.Their plasma D-dimer levels,blood platelet count,and lymphocyte count were detected and PLR was calculated.The D-dimer and PLR levels in BC patients and their correlations with clinical characteristics and prognosis were analyzed.Results The preoperative levels of D-dimer(1.13[0.62,2.18]mg/L)and PLR(135.2[106.6,166.5])in BC patients were significantly higher than that(D-dimer:0.35[0.16,0.59]mg/L;PLR:102.9[88.4,115.8])in healthy controls(P<0.001).The preoperative levels of D-dimer(1.39[0.78,2.33]mg/L)and PLR(152.2[118.0,169.3])in the postoperative recurrence group were significantly higher than that(D-dimer:0.35[0.16,0.59]mg/L;PLR:102.9[88.4,115.8])in the postoperative non-recurrence group(P<0.001).The areas under the receiver operating characteristics(ROC)curve(AUC^(ROC))of D-dimer for the diagnosis and recurrence of BC were 0.891 and 0.724,respectively.The AUC^(ROC) of PLR for the diagnosis and recurrence of BC were 0.735 and 0.689,respectively.The AUC^(ROC) of the combination of D-dimer and PLR were 0.907 and 0.762,respectively.Plasma D-dimer levels were significantly positively correlated with lymph node metastasis(P=0.02)and distant metastasis(P=0.03)of BC,while PLR was significantly associated with lymph node metastasis of BC(P<0.001).The disease-free survival(DFS)rate of the combination group with high D-dimer and PLR levels was significantly lower than that with low D-dimer and PLR levels(Median survival time:24.8 months vs 30.5 months,P=0.048).Conclusion The preoperative levels of D-dimer and PLR are significantly correlated with lymph node metastasis and distant metastasis of BC,which may predict the surgical prognosis of BC.