血小板和淋巴细胞比值联合CA19-9在胆囊癌术后患者预后评估中的价值

doi:10.3877/cma.j.issn.2095-3232.2024.02.008

中华肝脏外科手术学电子杂志 ›› 2024, Vol. 13 ›› Issue (02) : 163 -168. doi: 10.3877/cma.j.issn.2095-3232.2024.02.008

所属专题：综述；临床研究；

临床研究

血小板和淋巴细胞比值联合CA19-9在胆囊癌术后患者预后评估中的价值

马振威¹, 朱博¹, 刘赋斌¹, 邓正栋², 王剑明³^,^†(

)

^1. 430064　武汉科技大学附属天佑医院肝胆胰外科
^2. 430030　武汉，华中科技大学同济医学院附属同济医院小儿外科
^3. 430064　武汉科技大学附属天佑医院肝胆胰外科；430030　武汉，华中科技大学同济医学院附属同济医院胆胰外科

收稿日期:2023-12-26 出版日期:2024-04-10
通信作者: 王剑明
基金资助:
国家自然科学基金(81874062，82072730)

Evaluation value of platelet-to-lymphocyte ratio combined with CA19-9 for postoperative prognosis of patients with gallbladder cancer

Zhenwei Ma¹, Bo Zhu¹, Fubin Liu¹, Zhengdong Deng², Jianming Wang³^,^†()

^1. Department of Hepatobiliary and Pancreatic Surgery, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430064, China
^2. Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
^3. Department of Hepatobiliary and Pancreatic Surgery, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430064, China; Department of Hepatobiliary and Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China

Received:2023-12-26 Published:2024-04-10
Corresponding author: Jianming Wang

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引用本文：

马振威, 朱博, 刘赋斌, 邓正栋, 王剑明. 血小板和淋巴细胞比值联合CA19-9在胆囊癌术后患者预后评估中的价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(02): 163-168.

Zhenwei Ma, Bo Zhu, Fubin Liu, Zhengdong Deng, Jianming Wang. Evaluation value of platelet-to-lymphocyte ratio combined with CA19-9 for postoperative prognosis of patients with gallbladder cancer[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(02): 163-168.

目的

探讨术前血小板和淋巴细胞比值（PLR）联合CA19-9在胆囊癌患者术后预后评估中的价值。

方法

回顾性分析2015年12月至2020年12月华中科技大学同济医学院附属同济医院收治的67例胆囊癌术后患者临床资料。其中男28例，女39例；平均年龄（58±10）岁。患者均签署知情同意书，符合医学伦理学规定。生存分析采用Kaplan-Meier法和Log-rank检验；Cox多因素回归分析影响胆囊癌患者术后预后的独立危险因素；采用ROC曲线下面积（AUC）分析PLR +CA19-9预测胆囊癌患者术后预后的能力。

结果

PLR、CA19-9、PLR + CA19-9对胆囊癌患者术后3年总体生存期（OS）预测的ROC曲线分析显示，最佳界值分别为162、38、0.65。Cox多因素回归分析显示，PLR≥162和CA19-9≥38 kU/L是胆囊癌患者术后预后的独立危险因素（HR=3.093，3.852；P<0.05）。低水平和高水平PLR + CA19-9组中位OS分别为43、15个月，差异有统计学意义（χ²=44.342，P<0.05）。PLR预测胆囊癌患者术后1、3年无进展生存期的AUC分别为0.741、0.777，CA19-9相应为0.838、0.780，PLR + CA19-9相应为0.901、0.882。

结论

术前PLR联合CA19-9在胆囊癌患者术后预后评估中的预测价值大于PLR或CA19-9单独评估，有一定的临床应用价值。

关键词: 胆囊癌, 血小板, 淋巴细胞, 血小板和淋巴细胞比值（PLR）, CA19-9, 预后

Objective

To evaluate the value of preoperative platelet-to-lymphocyte ratio (PLR) combined with CA19-9 in evaluating postoperative prognosis of patients with gallbladder cancer.

Methods

Clinical data of 67 patients with gallbladder cancer admitted to Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from December 2015 to December 2020 were retrospectively analyzed. Among them, 28 patients were male and 39 female, aged (58±10) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The independent risk factors of postoperative prognosis of patients with gallbladder cancer were identified by multivariate Cox regression analysis. The efficiency of PLR + CA19-9 for predicting postoperative prognosis of patients with gallbladder cancer was assessed by delineating the area under ROC curve (AUC).

Results

ROC curve analysis showed that the optimal thresholds of PLR, CA19-9 and PLR + CA19-9 for predicting 3-year overall survival (OS) of patients with gallbladder cancer were 162, 38 and 0.65, respectively. Multivariate Cox regression analysis indicated that PLR≥162 and CA19-9≥38 kU/L were the independent risk factors for postoperative prognosis of patients with gallbladder cancer (HR=3.093, 3.852; P<0.05). The median OS in the low and high PLR + CA19-9 groups was 43 and 15 months, and the difference was statistically significant (χ²=44.342, P<0.05). The AUC of PLR in predicting postoperative 1- and 3-year progression-free survival of patients with gallbladder cancer was 0.741 and 0.777, 0.838 and 0.780 for CA19-9, and 0.901 and 0.882 for PLR + CA19-9, respectively.

Conclusions

Preoperative PLR combined with CA19-9 has higher value in predicting postoperative prognosis of patients with gallbladder cancer compared with PLR or CA19-9alone, which is of certain value in clinical application.

Key words: Gallbladder cancer, Platelet, Lymphocytes, Platelet-lymphocyte ratio (PLR), CA19-9, Prognosis

表1 PLR和CA19-9对胆囊癌术后患者3年OS预测的ROC曲线分析

影响因素	约登指数	最佳界值	敏感度	特异度	AUC	95%CI	P值
PLR	0.537	162	0.537	1.000	0.777	0.645～0.908	0.008
CA19-9	0.619	38	0.619	1.000	0.780	0.654～0.907	0.029
PLR + CA19-9	0.722	0.65	0.822	0.899	0.906	0.819～0.992	0.004

表1 PLR和CA19-9对胆囊癌术后患者3年OS预测的ROC曲线分析

影响因素	约登指数	最佳界值	敏感度	特异度	AUC	95%CI	P值
PLR	0.537	162	0.537	1.000	0.777	0.645～0.908	0.008
CA19-9	0.619	38	0.619	1.000	0.780	0.654～0.907	0.029
PLR + CA19-9	0.722	0.65	0.822	0.899	0.906	0.819～0.992	0.004

图1 PLR、CA19-9对胆囊癌患者术后3年OS预测的ROC曲线注：PLR为血小板和淋巴细胞比值，AUC为曲线下面积，OS为总体生存期

表2 PLR+CA19-9与胆囊癌术后患者临床病理指标的相关性

影响因素	类别	PLR + CA19-9		χ²值	P值
影响因素	类别	低水平组	高水平组	χ²值	P值
Plt（×10⁹/L）	≥247/<247	6/24	23/14	11.997	0.001
淋巴细胞（×10⁹/L）	≥1.7/<1.7	18/12	9/28	8.764	0.003
PLR	≥162/<162	0/30	27/10	36.669	0.001
CA19-9（kU/L）	≥38/<38	5/25	28/9	23.080	0.001
胆固醇（mmol/L）	≥3.4/<3.4	26/4	19/18	9.369	0.002
ALT（U/L）	≥48/<48	5/25	18/19	7.517	0.006
AST（U/L）	≥40/<40	4/26	14/23	5.063	0.024
AFP（μg/L）	≥2.7/<2.7	17/13	20/17	0.046	0.831
CEA（μg/L）	≥1.47/<1.47	23/7	30/7	0.195	0.659
WBC（×10⁹/L）	≥8/<8	3/27	11/26	3.902	0.048
性别	男/女	15/15	24/13	1.505	0.220
年龄（岁）	≥60/<60	15/15	21/16	0.304	0.581
AJCC分期	Ⅰ/Ⅱ/Ⅲ	18/5/7	18/14/5	3.908	0.142
肿瘤分化	低/中/高	14/12/6	6/20/9	5.585	0.067

表2 PLR+CA19-9与胆囊癌术后患者临床病理指标的相关性

影响因素	类别	PLR + CA19-9		χ²值	P值
影响因素	类别	低水平组	高水平组	χ²值	P值
Plt（×10⁹/L）	≥247/<247	6/24	23/14	11.997	0.001
淋巴细胞（×10⁹/L）	≥1.7/<1.7	18/12	9/28	8.764	0.003
PLR	≥162/<162	0/30	27/10	36.669	0.001
CA19-9（kU/L）	≥38/<38	5/25	28/9	23.080	0.001
胆固醇（mmol/L）	≥3.4/<3.4	26/4	19/18	9.369	0.002
ALT（U/L）	≥48/<48	5/25	18/19	7.517	0.006
AST（U/L）	≥40/<40	4/26	14/23	5.063	0.024
AFP（μg/L）	≥2.7/<2.7	17/13	20/17	0.046	0.831
CEA（μg/L）	≥1.47/<1.47	23/7	30/7	0.195	0.659
WBC（×10⁹/L）	≥8/<8	3/27	11/26	3.902	0.048
性别	男/女	15/15	24/13	1.505	0.220
年龄（岁）	≥60/<60	15/15	21/16	0.304	0.581
AJCC分期	Ⅰ/Ⅱ/Ⅲ	18/5/7	18/14/5	3.908	0.142
肿瘤分化	低/中/高	14/12/6	6/20/9	5.585	0.067

表3 影响胆囊癌患者术后预后的单因素分析

影响因素	类别	例数	中位生存期（月）	χ²值	P值
淋巴细胞(×10⁹/L)	≥1.7/<1.7	27/40	35/17	13.397	0.001
PLR	≥162/<162	27/40	15/33	24.202	0.001
CA19-9 (kU/L)	≥38/<38	33/34	15/32	20.620	0.001
AFP (μg/L)	≥2.7/<2.7	37/30	25/24	7.012	0.008

表3 影响胆囊癌患者术后预后的单因素分析

影响因素	类别	例数	中位生存期（月）	χ²值	P值
淋巴细胞(×10⁹/L)	≥1.7/<1.7	27/40	35/17	13.397	0.001
PLR	≥162/<162	27/40	15/33	24.202	0.001
CA19-9 (kU/L)	≥38/<38	33/34	15/32	20.620	0.001
AFP (μg/L)	≥2.7/<2.7	37/30	25/24	7.012	0.008

表4 影响胆囊癌患者术后预后的Cox多因素回归分析

影响因素	b	SE(b)	Wald χ²	HR	95%CI	P值
AFP<2.71 μg/L	-0.300	0.297	1.021	0.741	0.414～1.325	0.312
淋巴细胞<1.70×10⁹/L	-0.314	0.385	0.665	0.730	0.343～1.554	0.415
PLR≥162	1.129	0.379	8.867	3.093	1.471～6.504	0.003
CA19-9≥38 kU/L	1.348	0.331	16.608	3.852	2.014～7.367	0.001

表4 影响胆囊癌患者术后预后的Cox多因素回归分析

影响因素	b	SE(b)	Wald χ²	HR	95%CI	P值
AFP<2.71 μg/L	-0.300	0.297	1.021	0.741	0.414～1.325	0.312
淋巴细胞<1.70×10⁹/L	-0.314	0.385	0.665	0.730	0.343～1.554	0.415
PLR≥162	1.129	0.379	8.867	3.093	1.471～6.504	0.003
CA19-9≥38 kU/L	1.348	0.331	16.608	3.852	2.014～7.367	0.001

图2 不同PLR + CA19-9水平胆囊癌患者术后总体生存的Kaplan-Meier曲线注：PLR为血小板和淋巴细胞比值

图3 PLR、CA19-9及PLR + CA19-9预测胆囊癌患者术后1、3年PFS的ROC曲线注：PLR为血小板和淋巴细胞比值，PFS为无瘤生存期

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Evaluation value of platelet-to-lymphocyte ratio combined with CA19-9 for postoperative prognosis of patients with gallbladder cancer

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Evaluation value of platelet-to-lymphocyte ratio combined with CA19-9 for postoperative prognosis of patients with gallbladder cancer