基于凝血酶原时间、纤维蛋白原和血小板平均容积的PFM评分系统对晚期胰腺癌病人生存的预测价值  

The clinical value of PFM scoring system based on PT,FBG and MPV in predicting the survival of patients with advanced pancreatic cancer

作　　者：宫学宇 汪帅 焦奥 华向东 Gong Xueyu;Wang Shuai;Jiao Ao;Hua Xiangdong(Department of Hepatobiliary and Pancreatic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Liaoning Shenyang 110042, China)

机构地区：[1]中国医科大学肿瘤医院辽宁省肿瘤医院肝胆胰外科,辽宁沈阳110042

出　　处：《腹部外科》2020年第5期359-365,375,共8页Journal of Abdominal Surgery

摘　　要：目的研究基于凝血酶原时间(PT)、纤维蛋白原(FBG)和血小板平均容积(MPV)的新的评分系统(PFM评分系统)对晚期胰腺癌病人生存的预测价值。方法回顾性收集2013年6月至2018年12月在中国医科大学肿瘤医院肝胆胰外科确诊并治疗的196例晚期胰腺癌病人的临床资料。运用受试者工作特征(ROC)曲线法或者中位数对连续变量进行分组。PFM评分系统由PT、FBG和MPV三个变量组成,其中PT<11.2 s、FBG<2.6 g/L和MPV<12.3 fl分别赋予0分,而PT≥11.2 s、FBG≥2.6 g/L和MPV≥12.3 fl则分别赋予1分。3个变量的评分相加即为PFM评分。根据PFM评分进一步将病人分为低危组(0或1分)、中危组(2分)和高危组(3分)。分析PFM评分与病人临床资料的相关关系,运用Kaplan-Meier法和Log-Rank检验比较PFM评分不同亚组之间的生存差异。运用Cox比例风险回归模型对生存状况进行单因素和多因素分析,确定独立预后因素。采用针对删失数据的时间依赖ROC曲线比较不同预测指标的预测性能。结果截至末次随访时,共178例(90.8%)病人死亡,18例(9.2%)病人存活;病人的中位总生存期(overall survival,OS)为6.8个月(1~32个月)。在单因素分析中,病人年龄、TNM分期、治疗前CA19-9、PT、FBG、MPV水平以及营养支持、免疫治疗与病人的OS显著相关(P<0.05);在多因素分析中,TNM分期、治疗前CA19-9、PT、FBG、MPV水平及营养支持、免疫治疗是OS的独立预测因素(P<0.05)。在整个队列以及Ⅲ期和Ⅳ期病人中,不同PFM评分的3组在OS上差异均有统计学意义(P<0.05),PFM评分是OS的独立预测因素。PFM评分系统在预测病人生存准确度上性能优于其组成性变量。结论PT、FBG和MPV是晚期胰腺癌病人生存的独立预测因素,由三者组成的PFM评分系统同样也是晚期胰腺癌病人生存的独立预测因素,且PFM评分系统的预测性能优于其组成各变量。Objective To study the prognostic value of PFM scoring system based on prothrombin time(PT),fibrinogen(FBG)and mean platelet volume(MPV)in the survival of patients with advanced pancreatic cancer.Methods The clinical data of 196 patients with advanced pancreatic cancer diagnosed and treated in the Department of Hepatobiliary Surgery of Cancer Hospital of China Medical University from June 2013 to December 2018 were retrospectively collected.The continuous variables were grouped by ROC curve analysis or median.PFM scoring system was composed of PT,FBG and MPV,in which PT<11.2 s,FBG<2.6 g/L and MPV<12.3 fl were given 0 points respectively,while PT≥11.2 s,FBG≥2.6 g/L and MPV≥12.3 fl were given 1 point respectively.The sum of the scores of the three variables is the PFM score.According to the PFM score,the patients were further divided into low-risk group(0 or 1 point),medium risk group(2 points)and high-risk group(3 points).The correlation between PFM score and clinical data were analyzed.The survival differences between different subgroups of PFM score were compared by Kaplan-Meier method and Log-rank test.Cox proportional risk regression model was used to determine the independent prognostic factors for overall survival(OS).The prediction performance of different prediction indexes was compared by using ROC curve which was time-dependent for censored data.Results At the end of the last follow-up,178 patients(90.8%)died and 18 patients(9.2%)survived.The median OS for the entire cohort was 6.8 months(Range:1-32 months).In univariate analysis,age,TNM stage,pre-treatment CA19-9,PT,FBG,MPV,nutritional support and immunotherapy were significantly correlated with OS(all P<0.05);in multivariate analysis,TNM stage,pre-treatment CA19-9,PT FBG,MPV and nutritional support and immunotherapy were confirmed as independent predictors for OS(all P<0.05).Significant differences in OS in patients with different PFM scores were found in the entire cohort,stageⅢand stageⅣpatients(all P<0.05).The time-dependent ROC curve anal

关 键 词：晚期胰腺癌 评分系统 生存 预测 

分 类 号：R657.5[医药卫生—外科学]