术前外周血血小板/淋巴细胞比值和血小板相关指标对晚期下咽鳞癌的预后价值

Prognostic Value of Preoperative Platelet-to-Lymphocyte Ratio and Platelet-Related Indexes in Advanced Hypopharyngeal Squamous Cell Carcinoma

目的:探讨术前外周血血小板(platelet,PLT)/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)和PLT相关指标[PLT平均体积(mean platelet volume,MPV)、PLT分布宽度(platelet distribution width,PDW)]对晚期(TNMⅢ/Ⅳ)下咽鳞癌患者长期预后的影响。方法:回顾性分析2003年1月至2012年12月我院诊治的176例晚期下咽鳞癌患者临床资料。使用X-tile法分析术前血指标[PLR、PLT、MPV、PDW、MPV/PLT计数(MPV to platelet count ratio,MPV/P)、PDW/PCT计数(PDW to platelet count ratio,PDW/P)],选取最佳截点(cut-off point)区分高、低两组。应用Pearson卡方检验或Fisher精确概率法对两组进行描述性分析,采用单因素和多因素Cox回归模型分析两组患者的PLR及其它临床病理因素与5年总生存期(overall survival,OS)、5年无病生存期(disease-free survival,DFS)的关系。结果:随访时间至2017年12月31日,平均随访时间(47.81±30.48)月。X-tile分析得出5年OS最佳截点:PLR为170.8, PLT为260×10~9/L, MPV为8.2fL, PDW为16.5%, MPV/P为0.036, PDW/P为0.0635;5年DFS最佳截点:PLR为139.6, PLT为271×10~9/L, MPV为11.1fL, PDW为16.5%, MPV/P为0.036,和PDW/P为0.0635。纳入单因素及多因素Cox分析得出影响5年OS的独立危险因素有:高PLR(170.8)、高PLT(260×10~9/L)、低MPV(8.2fL)、T分级、术后转移。影响5年DFS的独立危险因素有:高PLR(139.6)、高PDW(11.1%)、T分级、TNM分期。结论:PLR升高提示下咽鳞癌患者预后较差,或可作为其长期预后(5年OS、DFS)评估指标。

Objective:To investigate whether preoperative platelet-to-lymphocyte ratio(PLR)and platelet(PLT)-related indexes,mean platelet volume(MPV)and platelet distribution width(PDW),can be long-term prognostic indicators of patients with advanced(TNMⅢ/Ⅳ)hypopharyngeal squamous cell carcinoma(HPSCC).Method:Data of 176 HPSCC patients in our hospital from January 2003 to December 2012 were retrospectively studied.X-tile method was used to select best cut-off point for preoperative blood indexes[PLR,PLT,mean platelet volume(MPV),platelet distribution width(PDW),mean platelet volume to platelet count ratio(MPV/P),platelet distribution width to platelet count ratio(PDW/P)]to divide the patients into two groups(high and low).Pearson’s chi-squared test or Fisher exact test were used to conduct a descriptive analysis.Univariate and multivariate analysis were conducted to evaluate the relationship between clinicopathological factors like PLR and 5-year overall survival(OS)and 5-year disease-free survival(DFS)of patients in two groups.Result:Follow up was around 47.81 months until 31 December 2017.According to X-tile method,the optimal cut-off points were 170.8 for PLR,260×10~9/L for PLT,8.2 fL for MPV,16.5%for PDW,0.036 for MPV/P and 0.064 for PDW/P in 5-year OS analysis.In 5-year DFS analysis,the optimal cut-off points were 139.6 for PLR,271×10~9/L for PLT,11.1 fL for MPV,and the rest were the same as those in the 5-year OS analysis.Univariate and multivariate analysis showed that the independent risk factors of 5-year OS were high PLR(>170.8),high PLT(>260×10~9/L),low MPV(≤8.2 fL),tumor classification and postoperative metastasis;the independent risk factors of 5-year DFS were high PLR(>139.6),high PDW(>11.1%),tumor classification and TNM stage.Conclusion:The increase in PLR suggests that the prognosis of patients with HPSCC is poor,and it could be an indicator of long-term prognosis(5-year OS and 5-year DFS).