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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2024, Vol. 13 ›› Issue (03) : 308 -312. doi: 10.3877/cma.j.issn.2095-3232.2024.03.009

临床研究

血小板相关参数对肝内胆管细胞癌根治性切除患者预后预测价值
黄俊豪1, 陈宗杰1, 胡添松1,†()   
  1. 1. 363000　福建省漳州市，第九〇九医院（厦门大学附属东南医院）介入科
  • 收稿日期:2024-02-23 出版日期:2024-06-10
  • 通信作者: 胡添松
  • 基金资助:
    福建省自然科学基金(2018J01152)

Prognostic value of platelet-related parameters in intrahepatic cholangiocarcinoma patients undergoing radical resection

Junhao Huang1, Zongjie Chen1, Tiansong Hu1,†()   

  1. 1. Department of Interventional Medicine, No.909 Hospital (Southeast Hospital Affiliated to Xiamen University), Zhangzhou 363000, China
  • Received:2024-02-23 Published:2024-06-10
  • Corresponding author: Tiansong Hu
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黄俊豪, 陈宗杰, 胡添松. 血小板相关参数对肝内胆管细胞癌根治性切除患者预后预测价值[J]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 308-312.

Junhao Huang, Zongjie Chen, Tiansong Hu. Prognostic value of platelet-related parameters in intrahepatic cholangiocarcinoma patients undergoing radical resection[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(03): 308-312.

目的

探讨血小板相关参数对肝内胆管细胞癌（ICC）根治性切除患者预后的预测价值。

方法

回顾性分析2016年1月1日至2019年12月31日在第九〇九医院行根治性切除的63例ICC患者临床资料。其中男41例，女22例；年龄39～65岁，中位年龄52岁。患者均签署知情同意书，符合医学伦理学规定。采用单因素和多因素Cox回归模型分析ICC患者预后影响因素。不同血小板参数的ICC患者生存分析采用Kaplan-Meier法和Log-rank检验。绘制ROC曲线分析Plt、血小板分布宽度（PDW）、血小板平均容积（MPV）等对患者无病生存期（DFS）和总体生存期（OS）的预测效能。

结果

Cox单因素和多因素分析显示，Plt≥185×109/L、PDW≥16.5%、MPV≤9.25 fl、肝门侵犯是ICC患者DFS的独立危险因素（HR=2.384，2.546，2.853，3.933；P<0.05）；Plt≥185×109/L、PDW≥16.5%、MPV≤9.25 fl、肝门侵犯、血管侵犯是OS的独立危险因素（HR=3.100，2.617，3.313，3.708，3.685；P<0.05）。生存分析显示，Plt≥185×109/L、PDW≥16.5%、MPV≤9.25 fl患者术后3年DFS分别为18.74%、19.54%、23.54%，对照组相应为89.34%、78.21%、85.45%（χ2=41.500，29.545，19.973；P<0.05）。Plt≥185×109/L、PDW≥16.5%、MPV≤9.25 fl患者术后3年OS分别为19.53%、18.64%、20.43%，对照组相应为91.53%、77.64%、87.94%（χ2=41.352，30.128，19.909；P<0.05）。ROC曲线分析显示，Plt预测术后3年OS曲线下面积为0.942、敏感度为0.968、特异度为0.744，PDW相应为0.843、0.742、0.875，MPV相应为0.886、0.781、0.935。

结论

术前Plt、PDW、MPV血小板参数是ICC根治性切除患者预后的独立影响因素，对患者生存预后有较大的预测价值。

关键词: 肝内胆管细胞癌, 肝肿瘤, 血小板计数, 血小板分布宽度, 血小板比容, 血小板平均容积
Objective

To investigate the prognostic value of platelet-related parameters in patients with intrahepatic cholangiocarcinoma (ICC) undergoing radical resection.

Methods

Clinical data of63 patients with ICC who underwent radical resection in No.909 Hospital from January 1, 2016 to December 31, 2019 were retrospectively analyzed. Among them, 41 patients were male and 22 female, aged from 39 to 65 years, with a median age of 52 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Prognostic factors of ICC patients were identified by univariate and multivariate Cox regression models. Survival analysis of ICC patients with different platelet-related parameters was conducted by using Kaplan-Meier method and Log-rank test. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficiency of Plt, platelet distribution width (PDW) and mean platelet volume (MPV) on disease-free survival (DFS) and overall survival (OS).

Results

Univariate and multivariate Cox analyses showed that Plt≥185×109/L, PDW≥16.5%, MPV≤9.25 fl and hilar invasion were the independent risk factors for DFS in ICC patients (HR=2.384, 2.546, 2.853, 3.933; P<0.05). Plt≥185×109/L, PDW≥16.5%, MPV≤9.25 fl, hilar invasion and vascular invasion were the independent risk factors for OS (HR=3.100, 2.617, 3.313, 3.708, 3.685; P<0.05). Survival analysis showed that the postoperative 3-year DFS rates of patients with Plt≥185×109/L, PDW≥16.5% and MPV≤9.25 fl were respectively 18.74%, 19.54%, 23.54%, and 89.34%, 78.21%, 85.45% in the control group (χ2=41.500, 29.545, 19.973; P<0.05). The postoperative 3-year OS of patients with Plt≥185×109/L,PDW≥16.5% and MPV≤9.25 fl were respectively 19.53%, 18.64%, 20.43%, and 91.53%, 77.64%, 87.94% in the control group (χ2=41.352, 30.128, 19.909; P<0.05). ROC curve analysis revealed that the area under the ROC curve of Plt for predicting postoperative 3-year OS was 0.942, 0.968 for the sensitivity and 0.744 for the specificity, and 0.843, 0.742, 0.875 for PDW, and 0.886, 0.781, 0.935 for MPV, respectively.

Conclusions

Preoperative platelet-related parameters including Plt, PDW and MPV are the independent prognostic factors for ICC patients undergoing radical resection, which possess a great predictive value for survival and prognosis of ICC patients.

Key words: Intrahepatic cholangiocarcinoma, Liver neoplasms, Platelet count (Plt), Platelet distribution width (PDW), Platelet volume ratio (PCT), Mean platelet volume (MPV)
表1 ICC根治性切除患者预后单因素分析
参数 DFS OS
HR 95%CI P值 HR 95%CI P值
Plt（≥185×109/L / <185×109/L） 4.358 2.534～7.875 <0.001 4.826 2.460～7.934 <0.001
PDW（≥16.5% / <16.5%） 3.032 2.109～7.902 <0.001 3.111 2.143～7.087 <0.001
PCT（≥0.16% / <0.16%） 3.730 2.017～8.705 <0.001 3.571 1.981～8.022 0.001
MPV（≤9.25 fl / >9.25 fl） 4.634 2.646～8.971 <0.001 4.940 2.714～8.347 <0.001
MPV/Plt（≤0.05 / >0.05） 5.880 2.263～9.715 <0.001 5.349 2.190～9.866 <0.001
肝门侵犯（是/否） 5.249 2.519～11.697 <0.001 5.290 2.464～11.357 <0.001
淋巴结转移（是/否） 3.926 1.910～8.067 <0.001 3.957 1.927～8.126 <0.001
胆管侵犯（是/否） 2.541 1.254～5.150 0.010 2.585 1.276～5.239 0.008
表2 ICC根治性切除患者预后多因素分析
参数 DFS OS
HR 95%CI P值 HR 95%CI P值
Plt≥185×109/L 2.384 1.861～4.181 0.011 3.100 1.830～7.586 0.012
PDW≥16.5% 2.546 1.501～4.770 0.028 2.617 1.520～5.025 0.026
MPV≤9.25 fl 2.853 1.933～6.251 0.030 3.313 1.021～6.651 0.047
肝门侵犯 3.933 1.700～5.335 0.003 3.708 1.636～5.589 0.008
血管侵犯 1.696 0.784～3.667 0.179 3.685 1.763～6.723 0.007
图1 血小板相关参数评估ICC根治性切除患者OS和DFS的Kaplan-Meier曲线注：ICC为肝内胆管癌，PDW为血小板分布宽度，MPV为血小板平均容积，OS为总体生存期，DFS为无病生存期
表3 血小板相关指标预测ICC患者预后ROC曲线分析
参数 敏感度 特异度 曲线下面积 95%CI P值
Plt 0.968 0.744 0.942 0.884～0.999 <0.001
PDW 0.742 0.875 0.843 0.739～0.947 <0.001
MPV 0.781 0.935 0.886 0.800～0.971 <0.001
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