Predictive role of peripheral blood cell parameters in the cancer development of hydatidiform moles
-
摘要:
目的 探讨首次清宫前红细胞分布宽度(RDW)、中性粒细胞/淋巴细胞比值(NLR)、血小板计数(PLT)以及中性粒细胞绝对值(N)在预测葡萄胎恶变中的临床价值。 方法 选取2011年1月—2021年5月于安徽理工大学第一附属医院清宫和随访的葡萄胎患者88例。根据术后血β-HCG的变化，将患者分为恶变组(76例)和未恶变组(12例)。分析2组患者首次清宫术前PLT、N、NLR和RDW，通过受试者工作曲线(ROC)计算曲线下面积(AUC)。 结果 (1) 恶变组患者的年龄、孕周、Logβ-HCG、RDW、血小板分布宽度(PDW)、N和NLR高于未恶变组，而淋巴细胞绝对值(L)和PLT低于未恶变组(P<0.05)。(2)多因素logistic回归分析显示：RDW、NLR和N的升高以及PLT的降低是葡萄胎恶变的独立危险因素。(3)ROC曲线分析：当清宫前RDW=14.95，AUC为0.925；当清宫前NLR=3.84，AUC为0.946；当清宫前N=7.12×109/L，AUC为0.893；当清宫前PLT=182.00×109/L，AUC为0.713。(4)根据RDW、NLR、PLT和N的临界点分组，高RDW、高NLR和高N组患者的恶变率分别高于低RDW、低NLR和低N组患者，但低PLT组患者的恶变率高于高PLT组患者(P<0.05)。 结论 葡萄胎患者首次清宫前RDW、NLR、PLT和N在预测葡萄胎恶变中具有一定的临床指导意义。 Abstract:Objective To investigate the clinical value of red blood cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), platelet count (PLT) and absolute neutrophil count (N) in predicting malignant transformation of hydatidiform mole prior to the initial curettage. Methods A total of 88 hydatidiform moles patients with curettage and follow-up in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Anhui University of Science and Technology from January 2011 to May 2021 were selected. Patients were divided into malignant group (76 cases) and non-malignant group (12 cases) according to the serum β-HCG results after curettage.The platelet count(PLT), neutrophil(N), neutrophil to lymphocyte ratio(NLR) and red blood cell distribution width (RDW) before the first curettage in the 2 groups were analyzed. The critical value of those markers was calculated by the area under the curve (AUC) statistic derived from the ROC curves. Results (1) Age, gestational weeks, Logβ-HCG, RDW, PDW, N and NLR in patients with malignant group were higher than that in non-malignant group, while absolute lymphocyte values (L) and PLT in the malignant group was significantly lower than that in non-malignant group(P<0.05). (2) Multivariate logistic regression analysis revealed that RDW, NLR and N increase as well as PLT decreased were independent risk factors for hydatidiform mole canceration. (3) ROC curve analysis that among the clinical markers measured before first curettage, for RDW= 14.95, NLR=3.84, N=7.12×109/L and PLT=182.00×109/L, the AUC was estimated as 0.925, 0.946, 0.893 and 0.713, respectively. (4)According to the threshold grouping of RDW, NLR, N and PLT, the malignant transformation rate of high RDW, NLR and N group were higher than patients in the low RDW, NLR and N group, while the malignant transformation rate of low PLT was higher than patients in the high PLT group (P<0.05). Conclusion RDW, NLR, PLT and N with hydatidiform mole patients before the first curettage have certain clinical guiding significance in predicting the malignant transformation of hydatidiform moles. -
图 1 RDW、NLR、PLT和N对葡萄胎恶变预测的ROC曲线]
Figure 1. ROC curves of RDW, NLR, PLT and N for predicting malignant transformation of hydatidiform mole
表 1 2组葡萄胎患者临床指标比较
Table 1. Comparison of clinical indexes between the two groups of patients with hydatidiform mole
组别 例数 年龄
(x±s，岁)孕周
(x±s，周)孕次
[M(P25, P75)，次]产次
[M(P25, P75)，次]流产次数
[M(P25, P75)，次]Logβ-HCG
(x±s，IU/L)未恶变组 76 28.43±7.16 8.21±2.31 1.5(1.0，2.0) 0(0，1) 0.00(0.00，1.00) 4.89±0.43 恶变组 12 36.08±8.89 10.05±3.03 2.5(1.0，4.0) 1(1，1) 1.50(0.00，2.25) 5.48±1.71 统计量 -3.325a 1.996a -1.717b -1.058b -1.681b -2.589a P值 0.001 0.049 0.086 0.290 0.093 0.011 注：a为t值，b为Z值。 
下载: 导出CSV
表 2 2组葡萄胎患者血细胞计数指标的比较
Table 2. Comparison of blood cell count indexes between two groups of patients with hydatidiform mole
组别 例数 WBC
(x±s, ×109/L)HB
(x±s, g/L)PLT
(x±s, ×109/L)MCV
(x±s, fL)MPV
(x±s, fL)RDW
(x±s)PDW
(x±s)未恶变组 76 6.50±1.66 111.89±13.75 209.39±61.20 86.93±6.70 10.78±1.29 13.14±0.89 12.99±2.14 恶变组 12 6.18±1.54 109.17±21.51 170.67±27.87 87.03±7.37 11.33±1.47 14.91±0.92 14.44±2.51 统计量 0.545a 0.587a 3.627a -0.050a -1.360a -6.349a -2.129a P值 0.587 0.559 0.001 0.961 0.177 < 0.001 0.036 组别 例数 N(x±s,
×109/L)L(x±s,
×109/L)M[M(P25, P75),
×109/L]NLR
(x±s)NMR
[M(P25, P75)]PLR
(x±s)LMR
[M(P25, P75)]未恶变组 76 4.21±1.37 1.72±0.47 0.41(0.34, 0.55) 2.55±0.93 9.82(7.70, 11.89) 129.76±47.60 4.10(3.05, 5.21) 恶变组 12 6.94±1.67 1.53±0.25 0.46(0.36, 0.46) 4.55±0.94 15.04(9.24, 17.65) 128.57±33.43 3.25(2.33, 4.38) 统计量 -6.214a 2.133a -0.979b -6.889a -2.213b 0.083a -1.319b P值 < 0.001 0.043 0.327 < 0.001 0.021 0.934 0.187 注：a为t值，b为Z值。
下载: 导出CSV
表 3 影响葡萄胎患者预后外周血细胞计数指标的多因素分析
Table 3. Multivariate analysis of peripheral blood cell count index affecting prognosis of patients with hydatidiform mole
变量 B SE Waldχ2 P值 OR值 95% CI RDW 2.049 0.861 5.667 0.017 7.759 1.436~41.917 PDW 0.746 0.444 2.816 0.093 2.108 0.882~5.037 NLR 1.748 0.752 5.407 0.020 5.745 1.316~25.076 PLT -0.037 0.016 5.115 0.024 0.963 0.933~0.995 N 1.813 0.592 9.366 0.002 6.128 1.919~19.570 L -4.362 2.495 3.055 0.080 0.013 0.000~1.696 NMR -0.200 0.295 0.461 0.497 0.819 0.460~1.459
下载: 导出CSV
表 4 RDW、NLR、N和PLT对葡萄胎恶变的预测价值
Table 4. Predictive value of RDW, NLR, N and PLT for malignant transformation of hydatidiform mole
指标 AUC SE 95% CI 临界值 灵敏度
(%)特异度
(%)RDW 0.925 0.033 0.860~0.990 14.95 50.0 97.4 NLR 0.946 0.025 0.896~0.995 3.84 83.3 93.4 N 0.893 0.046 0.804~0.982 7.12×109/L 66.7 97.4 PLT 0.713 0.061 0.594~0.832 182.00×109/L 65.8 83.3
下载: 导出CSV
-
[1] MOEIN-VAZIRI N, FALLAHI J, NAMAVAR-JAHROMI B, et al. Clinical and genetic-epignetic aspects of recurrent hydatidiform mole: a review of literature[J]. Taiwan J Obstet Gynecol, 2018, 57(1): 1-6. doi: 10.1016/j.tjog.2017.12.001 [2] VANICHTANTIKUL A, HODGE K G, SOMPARN P, et al. Proteomic identification of predictive biomarkers for malignant transformation in complete hydatidiform moles[J]. Placenta, 2019, 77(2): 58-64. [3] SHAABAN A M, REZVANI M, HAROUN R R, et al. Gestational trophoblastic disease: clinical and imaging features[J]. Radiographics, 2017, 37(2): 681-700. doi: 10.1148/rg.2017160140 [4] 焦澜舟, 王亚萍, 姜继勇, 等. 葡萄胎集中化管理临床意义的探讨[J]. 中华妇产科杂志, 2018, 53(6): 390-395. doi: 10.3760/cma.j.issn.0529-567x.2018.06.006JIAO L Z, WANG Y P, JIAN J Y, et al. Clinical significance of centralized surveillance of hydatidiform mole[J]. Chinese Journal of Obstetrics and Gynecology, 2018, 53(6): 390-395. doi: 10.3760/cma.j.issn.0529-567x.2018.06.006 [5] MLEKO M, PITYNSKI K, PLUTA E, et al. Role of systemic inflammatory reaction in female genital organ malignancies-state of the art[J]. Cancer Manag Res, 2021, 13: 5491-5508. doi: 10.2147/CMAR.S312828 [6] ABU-SHAWER O, ABU-SHAWER M, HIRMAS N, et al. Hematologic markers of distant metastases and poor prognosis in gynecological cancers[J]. BMC Cancer, 2019, 19(1): 141-145. doi: 10.1186/s12885-019-5326-9 [7] NGAN H Y S, SECKL M J, BERKOWITZ R S, et al. Update on the diagnosis and management of gestational trophoblastic disease[J]. Int J Gynaecol Obstet, 2018, 143(Suppl 2): 79-85. [8] AMIN-BEIDOKHTI M, SADEGHI H, PIRJANI R, et al. Differential expression of Hsa-miR-517a/b in placental tissue may contribute to the pathogenesis of preeclampsia[J]. J Turk Ger Gynecol Assoc, 2021, 22(4): 273-278. doi: 10.4274/jtgga.galenos.2021.2021.0062 [9] 王丽娟, 冯凤芝, 林仲秋. 《2020 NCCN妊娠滋养细胞肿瘤临床实践指南(第一版)》解读[J]. 中国实用妇科与产科杂志, 2020, 36(1): 74-79. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGSF202103017.htmWANG L J, FENG F Z, LIN Z Q. Interpretation of 2020NCCN Clinical Practice Guidelines for Gestational Trophoblastic Tumors (First edition)[J]. Chinese Journal of Practical Gynecology and Obstetrics, 2020, 36(1): 74-79. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGSF202103017.htm [10] 吴龙英, 韦雯雯, 颜士杰. 155例妊娠滋养细胞疾病临床资料分析[J]. 中华全科医学, 2017, 15(3): 457-459. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.029WU L Y, WEI W W, YAN S J. A clinical analysis of gestational trophoblastic disease: report of 155 cases[J]. Chinese Journal of General Practice, 2017, 15(3): 457-459. doi: 10.16766/j.cnki.issn.1674-4152.2017.03.029 [11] 栾海霞, 陈思, 曾小莉, 等. 全血细胞计数指标监测大动脉炎疾病活动性中的作用[J]. 中华检验医学杂志, 2020, 43(10): 1032-1038. doi: 10.3760/cma.j.cn114452-20200327-00311LUAN H X, CHEN S, ZENG X L, et al. Role of whole blood cell count indicators in monitoring the activity of Takayasu arteritis[J]. Chinese Journal of Laboratory Medicine, 2020, 43(10): 1032-1038. doi: 10.3760/cma.j.cn114452-20200327-00311 [12] YAO D S, WANG Z W, CAI H F, et al. Relationship between red cell distribution width and prognosis in patients with breast cancer after operation: a retrospective cohort study[J]. Biosci Rep, 2019, 39(7): BSR20190740. DOI: 10.142/BSR20190740. [13] KIM K, YU J, PARK J Y, et al. Low preoperative lymphocyte-to-monocyte ratio is predictive of the 5-year recurrence of bladder tumor after transurethral resection[J]. J Pers Med, 2021, 11(10): 947. doi: 10.3390/jpm11100947 [14] QIN Y Y, WANG P, HUANG Z B, et al. The value of red cell distribution width in patients with ovarian cancer[J]. Medicine, 2017, 96(17): e6752. DOI: 10.10971/MD.0000000000006752. [15] ZHANG L L, XIE Y J, ZHAN L L. The potential value of red blood cell distribution width in patients with invasive hydatidiform mole[J]. J Clin Lab Anal, 2019, 33(4): e22846. DOI: 10.1002/jcla.22846. [16] BLOMQVIST L R F, STRANDELL A M, BAGHAEI F, et al. Platelet aggregation in healthy women during normal pregnancy -a longitudinal study[J]. Platelets, 2019, 30(4): 438-444. doi: 10.1080/09537104.2018.1492106 [17] PENG Y F, WEI Q, SUN J F, et al. First-trimester platelet count as a predictive biomarker for neonatal birth weight among pregnant women at advanced maternal age[J]. Clin Appl Thromb Hemost, 2020, 26(12): 1076029619886907. DOI: 10.1177/1076029619886907. [18] 张素素, 邵军晖, 张六连. 中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值、β人绒毛膜促性腺激素和宫腔团块最大直径对葡萄胎预后的预测价值[J]. 广西医学, 2019, 41(22): 2875-2878. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYX201922017.htmZHANG S S, SHAO J J, ZHANG L L. Predictive value of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, human chronic gonadotropin and maximum diameter of intrauterine mass for prognosis of hydatidiform moles[J]. Guangxi Medical Journal, 2019, 41(22): 2875-2878. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYX201922017.htm [19] BACANAKGIL B H, KABAN I, UNAL F, et al. Predictive value of hematological inflammatory markers in endometrial neoplasia[J]. Asian Pac J Cancer Prev, 2018, 19(6): 1529-1532. [20] 潘婉婉, 董孟浩, 余发智, 等. 外周血炎症指标NLR、PLR、LMR预测乳腺癌新辅助化疗疗效的价值[J]. 中华全科医学, 2021, 19(9): 1442-1446. doi: 10.16766/j.cnki.issn.1674-4152.002081PAN W W, DONG M H, YU F Z, et al. Value of peripheral inflammatory markers NLR, PLR and LMR in predicting the efficacy of neoadjuvant chemotherapy for breast cancer[J]. Chinese Journal of General Practice, 2021, 19(9): 1442-1446. doi: 10.16766/j.cnki.issn.1674-4152.002081 [21] 蒋丽. 对接受葡萄胎清宫术和化疗的葡萄胎患者进行综合护理的效果分析[J]. 当代医药论丛, 2018, 16(12): 253-255. doi: 10.3969/j.issn.2095-7629.2018.12.181JIANG L. The effect of comprehensive nursing care on patients receiving hydatidiform hydatidialysis and chemotherapy was analyzed[J]. Contemporary Medical Symposium, 2018, 16(12): 253-255. doi: 10.3969/j.issn.2095-7629.2018.12.181 [22] 刘睿, 张涛红, 胡娇娇, 等. 外周血系统性炎症标志物预测完全性葡萄胎恶变的价值研究[J]. 实用妇产科杂志, 2020, 36(1): 31-36. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202001012.htmLIU R, ZHANG T H, HU J J, et al. Predictive value of peripheral systemic inflammatory markers in the malignancy transformation of complete hydatidiform mole[J]. Journal of Practical Obstetrics and Gynecology, 2020, 36(1): 31-36. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202001012.htm -
点击查看大图
图(1) / 表(4)
计量
- 文章访问数: 137
- HTML全文浏览量: 36
- PDF下载量: 2
- 被引次数: 0
