治疗前血小板水平与胰腺癌预后相关性的Meta分析

摘要

目的 系统评价治疗前外周血血小板水平作为胰腺癌患者预后指标的价值.方法 计算机检索PubMed、EMBASE、Cochrane图书馆、中国知网、万方、维普数据库,搜集有关血小板与胰腺癌患者预后的文章,由两位评价者独立进行文献检索、纳入排除、资料信息提取和质量评价,选择总生存作为主要指标,风险比作为预后效应量,采用RevMan 5.3软件进行Meta分析.结果 最终纳入15篇文献,共计2420例胰腺癌患者.Meta分析结果显示:血小板计数升高与胰腺癌患者总生存时间减少显著相关,合并所有报道的风险比为1.38(95％置信区间1.11～1.71,P=0.004).合并11篇使用多因素回归方法计算风险比的文章,风险比为1.67(95％置信区间1.26～2.23,P=0.0004),提示血小板计数升高是胰腺癌预后不良的独立风险因素.亚组分析显示,接受根治性手术的患者,血小板计数的预后价值高于姑息性治疗的患者,两者风险比分别为2.19(95％置信区间1.59～3.02,P<0.0001)和1.63(95％置信区间1.12～2.36,P=0.01).在无转移患者中血小板水平与预后显著相关(风险比1.61,95％置信区间1.18～2.20,P=0.003);而合并所有纳入了转移患者的研究显示血小板水平与预后无关(风险比1.15,95％置信区间0.75～1.76,P=0.51).结论 治疗前外周血血小板计数升高是胰腺癌预后不良的风险因素,其在接受根治性手术切除的患者中作为预后指标的价值较高,在伴有转移的患者中预后价值较低.%Objective To clarify the role of platelet count in predicting the prognosis of pancreatic cancer patients through summarizing the current evidences by meta-analysis. Methods The PubMed,EMBASE,Cochrane library, CNKI,WANFANG,and VIP database were searched for studies investigating the relationship between platelet count and pancreatic cancer prognosis. The Newcastle-Ottawa scale was used to evaluate the quality of the literatures. Meta-analysis was performed using RevMan 5.3 software to analyze the prognostic value of platelet counts using the hazard ratio(HR) and 95％ confidence intervals (95％CI). Results A total of 15 studies including 2420 patients were included. The pooled HR of 1.38(95％CI 1.11～1.71,P=0.004)showed that patients with elevated platelet counts were expected to have poor overall survival(OS). Pooled of 11 studies using multivariate analysis revealed a HR of 1.67(95％CI 1.26～2.23,P=0.0004),suggesting elevated pretreatment platelet count was an adverse prognosis factor for pancreatic cancer patients. Subgroup analysis showed that prognostic value of platelet level was stronger in patient those received surgical resection(HR=2.19,95％CI 1.59～3.02,P<0.0001)followed by in patient received palliative therapy(HR=1.63,95％CI 1.12～2.36,P=0.01);additionally,in patients without metastasis the increased platelet count was significantly associated with decreased OS(HR=1.61,95％CI 1.18～2.20,P=0.003),but not in patients with metastasis(HR=1.15,95％CI 0.75～1.76,P=0.51). Conclusion Pretreatment platelet count is a prognosis factor in patients with pancreatic cancer. Patients with elevated platelet count may have decreased OS ,especially for those received surgical resection.