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( TNM Ⅲ/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260×109/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271×109/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 ×109/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 pa-tients with advanced (TNM Ⅲ/Ⅳ) hypopharyngeal squamous cell carcinoma (HPSCC). Method: Data of 176 HPSCC pa-tients 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 di-vide the patients into two groups (high and low). Pearson’s chi-squared test or Fisher exact test were used to conduct a de-scriptive 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, 260×109/L for PLT, 8. 2fL 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, 271×109/L for PLT, 11. 1fL for MPV, and the rest were the same as those in the 5-year OS analysis. Univariate and multivariate analysis showed that the in-dependent risk factors of 5-year OS were high PLR( >170. 8), high PLT( >260×109/L), low MPV(≤8. 2fL), 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).
展开▼
