PROGNOSTIC SIGNIFICANCE OF PREOPERATIVE PLATELET DISTRIBUTION WIDTH IN CHOLANGIOCARCINOMA PATIENTS AFTER SURGERY
Hanlong Zhu*, Lin Miao
Nanjing medical university the second affiliate hospital, Nanjing, China
Background: Activated platelets act a pivotal part in tumor proliferation, angiogenesis, metastasis, and immune escape. Platelet distribution width (PDW) is an index used to reflect platelet volume and activity. It has been reported that pretreatment PDW is regarded as a predictor in certain malignancies. Nevertheless, PDW in the evaluation of prognosis for cholangiocarcinoma (CCA) patients remains unclear. The purpose of this study is to investigate the predictive value of preoperative PDW in patients with CCA.
Methods: The research was conducted with retrospective analysis of the medical records of 98 CCA patients who underwent surgical resection between December 2008 and November 2018. Additionally, the optimal cut-off level was identified by Receiver operating characteristic (ROC) curve. After dichotomizing subjects, overall survival (OS) and recurrence-free survival (RFS) were assessed using Kaplan-Meier curve and log-rank test. Univariate and multivariate analyses (Cox proportional hazards model) were performed to determine the impact of PDW on survival time.
Results: Based on the ROC analysis, the optimal cut-off value of the PDW was 12.65 (sensitivity 75.9%, specificity 63.2%, area under the curve = 0.688, P = 0.011). Of the 98 subjects, 67 (68.4%) had high PDW. As unveiled by Kaplan-Meier analysis, patients with elevated PDW (PDW＞12.65 fL) were significantly linked to poor OS (P = 0.021) and shortened RFS (P = 0.035). Furthermore, increased PDW levels remained as an independent prognostic factor of OS (P = 0.023; hazard ratio (HR), 1.896; 95% confidence interval (CI), 1.093-3.290) and RFS (P = 0.022; HR, 1.818; 95% CI, 1.088-3.038), independent of clinical stages, vascular involvement, nervous infiltration or number of tumors.
Conclusions: Preoperative augment in PDW is a potential valuable predictive marker of poor survival in CCA patients after surgical resection.
Table 1. Univariate and multivariate analyses for predictive factors associated with overall (OS) and recurrence-free (RFS) survival.
Figure 1. Kaplan-Meier curves of overall (A) and recurrence-free survival (B) after surgical resection for cholangiocarcinoma. Platelet distribution width (PDW＞12.65 fL) was significantly associated with worse OS (P = 0.021) and RFS (P = 0.035).
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