术前平均红细胞体积对食管鳞癌的预后价值。
Prognostic value of preoperative mean corpuscular volume in esophageal squamous cell carcinoma.
机构信息
Department of Thoracic Oncology, Cancer Center, Sun Yat-Sen University, Guangzhou 510060, Guangdong Province, China.
出版信息
World J Gastroenterol. 2013 May 14;19(18):2811-7. doi: 10.3748/wjg.v19.i18.2811.
AIM
To evaluate whether preoperative mean corpuscular volume (MCV) is a prognostic indicator in patients with resectable esophageal squamous cell carcinoma (ESCC).
METHODS
A total of 298 consecutive, prospectively enrolled patients with histologically diagnosed ESCC who underwent surgery with curative intent from 2001 to 2011 were retrospectively evaluated. Patients were excluded if they had previous malignant disease, distant metastasis at the time of primary treatment, a history of neoadjuvant treatment, had undergone non-radical resection, or had died of a non-tumor-associated cause. Survival status was verified in September 2011. Pathological staging was performed based on the 2010 American Joint Committee on Cancer criteria. Preoperative MCV was obtained from blood counts performed routinely within 7 d prior to surgery. Receiver operating characteristic (ROC) curve analysis was used to determine a cutoff for preoperative MCV.
RESULTS
The 298 patients consisted of 230 males and 68 females, with a median follow-up of 30.1 mo. ROC analysis showed an optimal cutoff for preoperative MCV of 95.6 fl. Fifty-nine patients (19.8%) had high (> 95.6 fl) and 239 (80.2%) had low (≤ 95.6 fl) preoperative MCV. Preoperative MCV was significantly associated with gender (P = 0.003), body mass index (P = 0.017), and preoperative red blood cell count (P < 0.001). The predicted 1-, 3- and 5-year overall survival (OS) rates were 72%, 60% and 52%, respectively. Median OS was significantly longer in patients with low than with high preoperative MCV (27.5 mo vs 19.4 mo, P < 0.001). Multivariate analysis showed that advanced pT (P = 0.018) and pN (P < 0.001) stages, upper thoracic location (P = 0.010), lower preoperative albumin concentration (P = 0.002), and high preoperative MCV (P = 0.001) were negative prognostic factors in patients with ESCC. Preoperative MCV also stratified OS in patients with T3, N1-N3, G2-G3 and stage III tumors.
CONCLUSION
Preoperative MCV is a prognostic factor in patients with ESCC.
目的
评估术前平均红细胞体积（MCV）是否为可切除食管鳞癌（ESCC）患者的预后指标。
方法
回顾性分析 2001 年至 2011 年间接受根治性手术的 298 例经组织学诊断为 ESCC 的连续前瞻性入组患者。如果患者有先前的恶性疾病、原发治疗时的远处转移、新辅助治疗史、非根治性切除或非肿瘤相关原因死亡，则将其排除在外。2011 年 9 月验证生存状态。病理分期根据 2010 年美国癌症联合委员会标准进行。术前 MCV从手术前 7 天内常规进行的血常规中获得。使用接收者操作特征（ROC）曲线分析确定术前 MCV 的截断值。
结果
298 例患者中男 230 例，女 68 例，中位随访 30.1 个月。ROC 分析显示术前 MCV 的最佳截断值为 95.6fl。59 例（19.8%）患者术前 MCV 较高（>95.6fl），239 例（80.2%）患者术前 MCV 较低（≤95.6fl）。术前 MCV 与性别（P=0.003）、体重指数（P=0.017）和术前红细胞计数（P<0.001）显著相关。预测的 1 年、3 年和 5 年总生存率（OS）分别为 72%、60%和 52%。低术前 MCV 组的中位 OS 明显长于高术前 MCV 组（27.5 个月比 19.4 个月，P<0.001）。多因素分析显示，进展期 pT（P=0.018）和 pN（P<0.001）分期、胸上段位置（P=0.010）、术前白蛋白浓度较低（P=0.002）和术前 MCV 较高（P=0.001）是 ESCC 患者的负预后因素。术前 MCV 还分层了 T3、N1-N3、G2-G3 和 III 期肿瘤患者的 OS。
结论
术前 MCV 是 ESCC 患者的预后因素。
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