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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2019, Vol. 15 ›› Issue (03) : 268 -274. doi: 10.3877/cma.j.issn.1673-5250.2019.03.006

所属专题： 文献；

论著

血小板与淋巴细胞比值对卵巢癌患者国际妇产科联盟临床分期的预测价值
唐英1, 李均1, 胡辉权1,†(), 徐凡1, 陈明星2   
  1. 1. 南充市中心医院妇科，四川　637000
    2. 川北医学院，四川南充　637000
  • 收稿日期:2019-01-08 修回日期:2019-05-04 出版日期:2019-06-01
  • 通信作者: 胡辉权

Predictive value of plate-to-lymphocyte ratio for International Federation of Obstetrics and Gynecology staging of ovarian cancer patients

Ying Tang1, Jun Li1, Huiquan Hu1,†(), Fan Xu1, Mingxing Chen2   

  1. 1. Department of Gynecology, Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China
    2. North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
  • Received:2019-01-08 Revised:2019-05-04 Published:2019-06-01
  • Corresponding author: Huiquan Hu
  • About author:
    Corresponding author: Hu Huiquan, Email:
  • Supported by:
    Science & Technology Pillar Program by Science and Technology Department of Sichuan Province(2015JY0056); Project of Bureau of Science & Technology and Intellectual Property Nanchong City(17YFZJ0005, 18YFZJ0012)
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引用本文：

唐英, 李均, 胡辉权, 徐凡, 陈明星. 血小板与淋巴细胞比值对卵巢癌患者国际妇产科联盟临床分期的预测价值[J/OL]. 中华妇幼临床医学杂志(电子版), 2019, 15(03): 268-274.

Ying Tang, Jun Li, Huiquan Hu, Fan Xu, Mingxing Chen. Predictive value of plate-to-lymphocyte ratio for International Federation of Obstetrics and Gynecology staging of ovarian cancer patients[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2019, 15(03): 268-274.

目的

探讨血小板与淋巴细胞比值(PLR)对卵巢癌患者国际妇产科联盟(FIGO)临床分期的预测价值。

方法

选择2005年1月至2017年1月，于南充市中心医院就诊的225例初治卵巢癌患者为研究对象。采取回顾性分析方法，根据FIGO分期，将其分为早期卵巢癌组(n＝85，FIGO分期为Ⅰ～Ⅱ期)和晚期卵巢癌组(n＝140，FIGO分期为Ⅲ～Ⅳ期)。采用Wilcoxon秩和检验，对2组患者的年龄、人体质量指数(BMI)、白细胞计数、血红蛋白(Hb)水平、PLR和中性粒细胞与淋巴细胞比值(NLR)进行统计学分析。采用χ2检验，对2组患者的组织病理学类型、合并恶性腹水患者所占比例、血清CA125水平>35 U/mL所占比例等进行统计学分析。绘制受试者工作特征(ROC)曲线，对PLR预测卵巢癌患者FIGO分期进行分析，并计算ROC曲线下面积(ROC-AUC)。采用多因素非条件logistic回归分析，判断PLR预测卵巢癌患者FIGO临床分期的准确性。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

结果

①2组患者的年龄、BMI、Hb水平和白细胞计数比较，差异均无统计学意义(P>0.05)；而其组织病理学类型、是否合并恶性腹水、血清CA125水平>35 U/mL、PLR和NLR比较，则差异均有统计学意义(χ2＝16.897、76.187、11.817、－5.252、－3.790, P均<0.05)。②组织病理学类型(OR＝2.460，95%CI＝1.246～4.856，P＝0.009)，是否合并恶性腹水(OR＝6.649，95%CI＝3.437～12.862，P<0.001)和PLR(OR＝1.005，95%CI＝1.001～1.009，P＝0.027)，均为预测卵巢癌患者FIGO分期的独立危险因素。③PLR对预测卵巢癌患者FIGO分期的ROC-AUC为0.709(95%CI：0.645～0.767，P<0.001)。根据约登指数最大原则，PLR预测卵巢癌患者FIGO临床分期的最佳临界值为157.14。其中，本研究225例初治卵巢癌患者中，PLR>157.14者为134例，PLR≤157.14者为91例。此时，PLR对预测卵巢癌患者FIGO分期的敏感度为72.9%，特异度为63.5%。

结论

PLR值可预测卵巢癌FIGO分期。当PLR>157.14时，卵巢癌患者FIGO临床分期为晚期的可能性较大。

关键词: 卵巢肿瘤, 肿瘤分期, 炎症, 血小板与淋巴细胞比值, ROC曲线, 妇女
Objective

To explore the predictive value of platelet-to-lymphocyte ratio (PLR) for International Federation of Obstetrics and Gynecology (FIGO) staging of ovarian cancer patients.

Methods

From January 2005 to January 2017, a total of 225 patients with primary ovarian cancer who were treated at Nanchong Central Hospital were selected into this study. According to different FIGO stagings, they were divided into early ovarian cancer group (n=85, FIGO stage Ⅰ-Ⅱ) and advanced ovarian cancer group (n=140, FIGO stage Ⅲ-Ⅳ). Wilcoxon rank sum test was used to statistically compare age, body mass index (BMI), white blood cell count, hemoglobin (Hb) level, PLR and neutrophil-to-lymphocyte ratio (NLR) between two groups. Chi-square test was used to statistically compare histopathological types, proportion of patients with ascites and proportion of serum CA125 level >35 U/mL. Then receiver operator characteristic (ROC) curve of PLR for predicting the FIGO staging of ovarian caner patients was drawn, and the area under ROC curve (ROC-AUC) was calculated. The optimal critical value of PLR for predicting the clincial staging of ovarian caner patients was obtained when the Youden index reaching the maximum value. And its sensitivity and specificity were calculated. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013. Informed consent was obtairned from each participates.

Results

①There were significant differences in histopathological types, malignant ascites or not, serum CA125 level > 35 U/mL, PLR and NLR between two groups (χ2=16.897, 76.187, 11.817, -5.252, -3.790; P all<0.05), while there were no significant differences in age, BMI, Hb level and WBC count between two groups (P>0.05). ②Histopathological type (OR=2.460, 95%CI=1.246-4.856, P=0.009), malignant ascites (OR=6.649, 95%CI=3.437-12.862, P<0.001) and PLR (OR=1.005, 95%CI=1.001-1.009, P=0.027) were independent risk factors for ovarian cancer patients with different FIGO staging. ③ROC curve analysis showed that PLR for predicting FIGO staging of ovarian cancer patients was 0.709 (95%CI: 0.645-0.767, P<0.001). According to the principle of maximum Youden index, the optimal critical value for PLR to predict FIGO staging of ovarian cancer patients was 157.14, of which 134 patients with PLR > 157.14 and 91 patients with PLR≤157.14. At this time, the sensitivity was 72.9%, and the specificity was 63.5%.

Conclusions

PLR value can predict FIGO staging of ovarian cancer. When PLR>157.14, the FIGO staging of ovarian cancer patients is more likely to be advanced.

Key words: Ovarian neoplasms, Neoplasm staging, Inflammasomes, Plate to lymphocyte ratio, ROC curve, Women
表1 225例卵巢癌患者的一般临床资料
项目 结果 项目 结果
年龄[岁，M(P25～P75)] 50(18～89) 恶性腹水[例数(%)] ?
BMI[kg/m2，M(P25～P75)] 22.6(15.6～30.9) ? 是 134(59.6)
FIGO分期[例数(%)] ? ? 否 91(40.4)
? Ⅰ期 44(19.6) 白细胞计数[×109/L，M(P25～P75)] 7.2(3.3～16.5)
? Ⅱ期 41(18.2) 中性粒细胞计数[×109/L，M(P25～P75)] 4.5(1.7～13.1)
? Ⅲ期 122(54.2) 淋巴细胞计数[×109/L，M(P25～P75)] 1.3(0.3～2.8)
? Ⅳ期 18(8.0) Hb [g/L，M(P25～P75)] 116(50～161)
组织病理学类型[例数(%)] ? 血小板计数[×109/L，M(P25～P75)] 245(77～589)
? 浆液性 151(67.1) PLR [M(P25～P75)] 178(3～746)
? 非浆液性 74(32.9) NLR [M(P25～P75)] 3.4(1.1～17.1)
血清CA125[U/mL，M(P25～P75)] 160.6(1.4～5 672.6) ? ?
表2 2组卵巢癌患者的临床特征比较
组别 例数 组织病理学类型[例数(%)] 恶性腹水[例数(%)] 血清CA125 [例数(%)]
浆液性 非浆液性 是 否 >35 U/mL ≤35 U/mL
早期卵巢癌组 85 43(19.1) 42(18.7) 25(11.1) 60(26.7) 58(25.8) 27(12.0)
晚期卵巢癌组 140 108(48.0) 32(14.2) 109(48.4) 31(13.8) 122(54.2) 18(8.0)
检验值 ? χ2＝16.897 χ2＝76.187 χ2＝11.817
P值 ? <0.001 <0.001 0.001
组别 例数 中性粒细胞计数[×109/L，M(P25～P75)] 年龄[岁，M(P25～P75)] BMI [kg/m2，M(P25～P75)] 白细胞计数[×109/L，M(P25～P75)]
早期卵巢癌 85 4.1(203.0～11.0) 50(18～89) 22.6(15.6～30.9) 7.2(3.6～16.5)
晚期卵巢癌 140 4.8(1.7～13.1) 50(1～80) 23.4(16.5～31.2) 7.5(3.3～16.2)
检验值 ? Z＝—1.966 Z＝—0.879 Z＝—1.799 Z＝—1.633
P值 ? 0.049 0.380 0.075 0.102
组别 例数 Hb [g/L，M(P25～P75)] PLR[M(P25～P75)] NLR[M(P25～P75)] 淋巴细胞计数[×109/L，M(P25～P75)]
早期卵巢癌 85 114.0(50.0～143.0) 145.0(10.4～550.0) 2.6(1.1～12.1) 1.4(0.6～2.5)
晚期卵巢癌 140 116.5(61.0～161.0) 215.9(2.9～746.3) 4.2(1.2～17.1) 1.2(0.3～2.8)
检验值 ? Z＝—0.076 Z＝—5.252 Z＝—3.790 Z＝—4.004
P值 ? 0.939 <0.001 <0.001 <0.001
表3 卵巢癌患者FIGO分期影响因素的多因素非条件logistic回归分析变量含义及赋值情况
自变量/因变量 变量名 赋值
FIGO分期 y FIGO 2014年手术-病理分期
组织病理学类型 x1 x1＝0表示除浆液性卵巢癌外的其他组织病理学类型，x1＝1表示浆液性卵巢癌
是否合并恶性腹水 x2 x2＝0表示未合并恶性腹水，x2＝1表示合并恶性腹水
血清CA125水平 x3 x3＝0表示血清CA125水平<35 U/mL，x3＝1表示血清CA125水平≥35 U/mL
PLR x4 x4表示实际PLR
NLR x5 x5表示实际NLR
表4 卵巢癌患者FIGO分期影响因素的多因素非条件logistic回归分析结果
影响因素 B SE Wald值 P值 OR值 OR值95%CI
常数项 －2.753 0.519 28.137 <0.001 0.064 —
组织病理学类型 0.900 0.347 6.728 0.009 2.460 1.246～4.856
是否合并恶性腹水 1.894 0.337 31.667 <0.001 6.649 3.437～12.862
血清CA125水平 0.781 0.404 3.731 0.053 2.183 0.989～4.819
NLR 0.023 0.084 0.074 0.786 1.023 0.868～1.206
PLR 0.005 0.002 4.900 0.027 1.005 1.001～1.009
图1 PLR预测卵巢癌患者FIGO分期的ROC曲线
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