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

doi:10.3877/cma.j.issn.1673-5250.2019.03.006

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(%)]
组别	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(%)]
组别	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

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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