肝细胞癌术前红细胞分布宽度的预后价值

目的探讨肝细胞癌术前红细胞分布宽度(RDW)的预后价值。方法采用回顾性队列研究方法。收集2002年4月至2017年8月国内3家医疗中心收治的1025例(西安交通大学第一附属医院586例、西安交通大学第二附属医院248例、青海大学附属医院191例)肝细胞癌病人的临床病理资料;男809例,女216例;年龄为(54±11)岁,年龄范围为16~83岁。1025例病人红细胞分布宽度变异系数(RDW-CV)平均值为14.3%,其中高RDW(RDW-CV>14.3%)病人347例,低RDW(RDW-CV≤14.3%)病人678例。观察指标:(1)肝细胞癌病人临床病理特征。(2)肝细胞癌病人预后影响因素分析。(3)随访及生存情况。(4)独立影响因素分层分析。采用门诊、电话或网络等方式进行随访,了解病人术后生存情况。随访时间截至2017年10月。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示,组间比较采用χ²检验。采用Graphpad Prism 7.0绘制生存曲线,采用Log-rank检验进行生存分析。采用COX比例风险模型进行单因素和多因素分析。结果(1)肝细胞癌病人临床病理特征:高RDW病人年龄(≤70岁、>70岁),肝硬化(无、有),肝功能Child-Pugh分级(A级、B级或C级),甲胎蛋白(≤200μg/L、>200μg/L),肿瘤数目(单发、多发)分别为313、34例,152、186例,161、53例,158、143例,186、109例;低RDW病人上述指标分别为641、37例,359、310例,415、48例,367、227例,547、131例,两者上述指标比较,差异均有统计学意义(χ²=6.709,6.787,23.906,7.114,34.375,P<0.05)。(2)肝细胞癌病人预后影响因素分析。单因素分析结果显示:年龄、肝功能Child-Pugh分级、甲胎蛋白、RDW-CV、肿瘤长径、肿瘤数目是影响病人预后的相关因素(风险比=1.388,1.432,1.534,1.455,2.813,1.505,95%可信区间为1.004~1.920,1.086~1.887,1.263~1.864,1.211~1.748,2.293~3.450,1.173~1.932,P<0.05)。多因素分析结果显示:年龄、RDW-CV、肿瘤长径和肿瘤数目是病人预后的独立影响因素(风险比=1.020,1.340,2.427,1.438,95%可信区间为1.007~1.032,1.027~1.749,1.801~3.272,1.057~1.956,P<0.05)。(3)随访及生存情况:1025例病人均获得随访,随访时间为1~124个月,中位随访时间为25个月。高RDW病人中位生存时间为23个月,低RDW病人中位生存时间为44个月,两者总体生存情况比较,差异有统计学意义(χ²=11.640,P<0.05)。(4)独立影响因素分层分析:针对年龄、肿瘤长径和肿瘤数目3个独立影响因素进行分层分析,结果显示:954例年龄≤70岁病人中,高RDW病人中位生存时间为25个月,低RDW病人中位生存时间为48个月,两者总体生存情况比较,差异有统计学意义(χ²=14.030,P<0.05)。71例年龄>70岁病人中,高RDW病人中位生存时间为11个月,低RDW病人中位生存时间为29个月,两者总体生存情况比较,差异无统计学意义(χ²=0.933,P>0.05)。459例肿瘤长径≤5 cm病人中,高RDW病人中位生存时间为44个月,低RDW病人中位生存时间为76个月,两者总体生存情况比较,差异有统计学意义(χ²=8.660,P<0.05)。487例肿瘤长径>5 cm病人中,高RDW病人中位生存时间为14个月,低RDW病人中位生存时间为18个月,两者总体生存情况比较,差异无统计学意义(χ²=2.950,P>0.05)。733例单发肿瘤病人中,高RDW病人中位生存时间为20个月,低RDW病人中位生存时间为48个月,两者总体生存情况比较,差异有统计学意义(χ²=13.530,P<0.05)。240例多发肿瘤病人中,高RDW病人中位生存时间为15个月,低RDW病人中位生存时间为20个月,两者总体生存情况比较,差异有统计学意义(χ²=6.820,P<0.05)。结论术前RDW可预测肝细胞癌病人的预后,高RDW病人预后更差。RDW在年龄≤70岁和肿瘤长径≤5 cm病人中具有更好的预测价值。

Prognostic value of preoperative red blood cell distribution width for hepatocellular carcinoma

Objective To investigate the prognostic value of preoperative red blood cell distribution width(RDW)for hepatocellular carcinoma(HCC).Methods The retrospective cohort study was conducted.The clinicopathological data of 1025 HCC patients who were admitted to three medical centers(586 in the First Affiliated Hospital of Xi'an Jiaotong University,248 in the Second Affiliated Hospital of Xi'an Jiaotong University and 191 in the Qinghai University Affiliated Hospital)between April 2002 and August 2017 were collected.There were 809 males and 216 females,aged(54±11)years,with a range from 16 to 83 years.The average coefficient of variation of RDW(RDW-CV)of 1025 patients was 14.3%.Of 1025 patients,347 cases had high RDW of RDW-CV>14.3%,and 678 had low RDW of RDW-CV≤14.3%.Observation indicators:(1)clinico-pathological data of HCC patients;(2)influencing factors for prognosis of HCC patients;(3)follow-up and survival.(4)stratified analysis of independent influencing factors.Follow-up was performed by outpatient examination,telephone interview or internet interview to detect postoperative survival of patients up to October 2017.Measurment data with normal distribution were represented as Mean±SD,and measurment data with skewed distribution were described as M(range).Count data were described as absolute numbers,and comparison between groups was analyzed using the chi-square test.The Graphpad Prism 7.0 was used to draw survival curves,and Log-rank test was used for survival analysis.Univariate and multivariate analyses were performed using the COX proportional hazard model.Results(1)Clinicopathological data of HCC patients:cases with age≤70 years or>70 years,cases without cirhhosis or with cirhhosis,cases of Child-Pugh grade A or Child-Pugh grade B or C,cases with the level of alpha fetoprotein(AFP)≤200μg/L or>200μg/L,cases with single tumor or multiple tumors were 313,34,152,186,161,53,158,143,186,109 for high RDW patients,versus 641,37,359,310,415,48,367,227,547,131 for low RDW patients,respectively,showing significant differences in above indicators between the two groups(χ²=6.709,6.787,23.906,7.114,34.375,P<0.05).(2)Influencing factors for prognosis of HCC patients:results of univariate analysis showed that age,Child-Pugh grade,AFP,RDW-CV,tumor diameter,the number of tumors were related factors for prognosis of patients(hazard ratio=1.388,1.432,1.534,1.455,2.813,1.505,95%confidence interval as 1.004-1.920,1.086-1.887,1.263-1.864,1.211-1.748,2.293-3.450,1.173-1.932,P<0.05).Results of multivariate analysis showed that age,RDW-CV,tumor diameter and the number of tumors were independent factors for prognosis of patients(hazard ratio=1.020,1.340,2.427,1.438,95%confidence interval as 1.007-1.032,1.027-1.749,1.801-3.272,1.057-1.956,P<0.05).(3)Follow-up and survival:1025 patients were followed up for 1-124 months,with a median follow-up time of 25 months.The median survival time was 23 months for high RDW patients,versus 44 months for low RDW patients,showing a significant difference in the overall survival between the two groups(χ²=11.640,P<0.05).(4)Stratified analysis of independent influencing factors:the results of stratified analysis of 3 independent influencing factors including age,tumor diameter and the number of tumors showed that in the 954 patients with age≤70 years,the median survival time was 25 months for high RDW patients,versus 48 months for low RDW patients,showing a significant difference in the overall survival between the two groups(χ²=14.030,P<0.05).In the 71 patients with age>70 years,the median survival time was 11 months for high RDW patients,versus 29 months for low RDW patients,showing no significant difference in the overall survival between the two groups(χ²=0.933,P>0.05).In the 459 patients with tumor diameter≤5 cm,the median survival time was 44 months for high RDW patients,versus 76 months for low RDW patients,showing a significant difference in the overall survival between the two groups(χ²=8.660,P<0.05).In the 487 patients with tumor diameter>5 cm,the median survival time was 14 months for high RDW patients,versus 18 months for low RDW patients,showing no significant difference in the overall survival between the two groups(χ²=2.950,P>0.05).In the 733 patients with single tumor,the median survival time was 20 months for high RDW patients,versus 48 months for low RDW patients,showing a significant difference in the overall survival between the two groups(χ²=13.530,P<0.05).In the 240 patients with multiple tumors,the median survival time was 15 months for high RDW patients,versus 20 months for low RDW patients,showing a significant difference in the overall survival between the two groups(χ²=6.820,P<0.05).Conclusions Preoperative RDW can be used as a predictive index for prognosis of HCC patients,and patients with high RDW have poorer prognosis.RDW have better predictive value in patients with age≤70 years or tumor diameter≤5 cm.