基于术前RDW-SD、RDW-CV评估乳腺癌淋巴转移患者预后  

Prognosis of RDW-SD and RDW-CV in breast cancer patients with lymphatic metastasis

作　　者：黄蕾 唐文佳 周琰 周佳烨 张春燕 杨静 王蓓丽 潘柏申 郭玮 HUANG Lei;TANG Wenjia;ZHOU Yan;ZHOU Jiaye;ZHANG Chunyan;YANG Jing;WANG Beili;PAN Baishen;GUO wei(Department of Clinical Laboratory,Xiamen Hospital,Zhongshan Hospital,Fudan University,Xiamen 361015,Fujian,China;Department of Clinical Laboratory,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Clinical Laboratory,Shanghai Geriatrics Center,Shanghai 201104,China)

机构地区：[1]复旦大学附属中山医院厦门医院检验科,福建厦门361015 [2]复旦大学附属中山医院检验科,上海200032 [3]上海市老年医学中心检验科,上海201104

出　　处：《检验医学》2024年第4期376-381,共6页Laboratory Medicine

基　　金：国家自然科学基金面上项目(81972000);国家自然科学基金面上项目(82172348);国家自然科学基金青年项目(81902139);上海市临床重点专科建设项目(shslczdzk03302);厦门市医疗卫生重点项目(YDZX20193502000002)。

摘　　要：目的 分析乳腺癌淋巴转移患者术前红细胞体积分布宽度标准差(RDW-SD)和红细胞体积分布宽度变异系数(RDW-CV)与其预后的关系。方法 选取2018年1月—2022年2月复旦大学附属中山医院厦门医院经术后病理确诊乳腺癌并发生淋巴转移的女性患者156例。收集患者术前RDW-CV和RDW-SD、临床病理指标,以及预后相关信息。采用Cox回归分析评估患者预后不良的影响因素。采用受试者工作特征(ROC)曲线分析RDW-SD和RDW-CV预测患者预后不良的效能。根据RDW-CV、RDW-SD的最佳临界值,将156例乳腺癌淋巴转移患者分为高表达组和低表达组,采用Kaplan-Meier生存曲线比较高表达组和低表达组无病生存率的差异。结果 不同TNM分期的乳腺癌淋巴转移患者之间RDW-SD、RDW-CV差异有统计学意义(P<0.001)。ROC曲线分析结果显示,RDW-CV诊断病理Ⅳ期[曲线下面积(AUC)=0.838,P<0.001)和患者预后不良(AUC=0.773,P<0.001)的效能均优于RDW-SD(AUC分别为0.780、0.729,P<0.05)。Cox回归分析结果显示,术前RDW-CV是预后不良的独立危险因素[风险比(HR)=1.46,95%可信区间(CI)为1.13~1.89,P=0.004]。Kaplan-Meier生存曲线分析结果显示,RDW-CV高表达组和RDW-SD高表达组无病生存率分别低于RDW-CV低表达组和RDW-SD低表达组(P<0.001)。结论 术前RDW-CV对乳腺癌淋巴结转移患者的预后评估价值优于RDW-SD。高RDW-CV是患者预后不良的独立危险因素。Objective To investigate the relationship between preoperative red blood cell distribution width-standard deviation(RDW-SD)and red blood cell distribution width-coefficient of variation(RDW-CV)and prognosis in breast cancer patients with lymphatic metastasis.Methods From January 2018 to February 2022,156 female breast cancer patients with lymphatic metastasis confirmed by postoperative pathology in Xiamen Hospital of Zhongshan Hospital of Fudan University were enrolled.The RDW-SD,RDW-CV,clinicopathological indicators and prognostic data of patients were collected.Cox regression model was used to look for risk factors for poor prognosis.The predictive values of RDW-SD and RDW-CV in poor prognosis were analyzed by receiver operating characteristic(ROC)curve.According the optimal values of RDW-CV and RDW-SD,the 156 breast cancer patients with lymphatic metastasis were classified into high and low expression groups.Disease-free survival was calculated using Kaplan-Meier survival analysis.Results There was statistical significance in RDW-SD and RDW-CV in patients with different TNM stages(P<0.001).RDW-CV in diagnosingⅣstage and evaluating poor prognosis[areas under curves(AUC)=0.838 and 0.773,respectively,P<0.001]were more effective than RDW-SD(AUC=0.780 and 0.729,respectively,P<0.05).Preoperative RDW-CV was an independent risk factor for poor prognosis[hazard ratio(HR)=1.46,95%confidence interval(CI)1.13-1.89,P=0.004].Postoperative disease-free survival rate of RDW-CV high expression group and RDW-SD high expression group were lower than those of low expression groups(P<0.001).Conclusions RDW-CV is superior to RDW-SD in preoperative prognosis assessment of breast cancer patients with lymphatic metastasis,and high RDW-CV is an independent risk factor for poor prognosis.

关 键 词：红细胞体积分布宽度标准差 红细胞体积分布宽度变异系数 乳腺癌 淋巴结转移 预后 

分 类 号：R446.11[医药卫生—诊断学]