目的:本研究旨在评估血常规作为早期食管癌(EEC)患者潜在炎症标志物的诊断价值。方法:选取2015年7月至2019年7月南京医科大学第一附属医院收治的314例经病理确诊的EEC患者行内镜黏膜下剥离术(ESD),进行病例对照研究。每个EEC患者在性别标准上与一个健康对照进行匹配,年龄(±2岁)。此外,总共40名受试者(20例和20例对照)也被纳入验证集.对两组间所选择的血液学参数进行统计学分析。进一步评估EEC患者术前血液指标与ESD术后临床病理特征的相关性。结果:单因素分析显示单核细胞指数(p<0.001),MCV(p=0.018),MCH(p=0.01),MPV(p=0.022),PT(p=0.003),PT-INR(p=0.003),与健康对照组相比,EEC患者的PDW(p<0.001)和MLR(p<0.001)具有统计学意义。多因素logistic回归分析进一步发现,PDW和MLR与早期食管癌的风险独立相关(均p<0.001)。在EEC患者中,较高的NLR(P=0.007)和MLR(P=0.015)水平与粘膜下浸润有统计学意义,而MLR水平与较大的肿瘤大小显着相关(P=0.030)。验证组的结果与主要组一致。结论:MLR和PDW的血液学参数可作为诊断EEC的辅助工具。此外,MLR值可以反映侵袭深度指数。
Aims: The present study was to evaluate the diagnostic value of routine blood test as potential inflammatory markers in early esophageal cancer (EEC) patients. Methods: A matched
case-control study was conducted by recruiting 314 patients who were pathologically diagnosed with EEC and then underwent Endoscopic Submucosal Dissection (ESD) from July 2015 to July 2019 in First Affiliated Hospital of Nanjing Medical University. Each EEC patient was matched against one healthy control on the criteria of gender, and age (±2 years). Additionally, a total of 40 subjects (20 cases and 20 controls) were also included in the validation set. Statistical analysis of selected hematological parameters was performed between the two groups. The correlation between preoperative blood indexes and clinicopathological characteristics after ESD in EEC patients were further assessed. Results: Mono-factor analysis showed that the index of monocyte (p<0.001), MCV (p=0.018), MCH (p=0.01), MPV (p=0.022), PT (p=0.003), PT-INR (p=0.003), PDW (p<0.001) and
MLR (p<0.001) were statistically significant in EEC patients when compared with those in healthy controls. Multivariate logistic regression analysis further identified that PDW and MLR was independently associated with the risk of early esophageal cancer (both p<0.001). The higher level of NLR (P=0.007) and MLR (P=0.015) were statistically significant with submucosal invasion in EEC patients and the level of
MLR were significantly associated with larger tumor size (P=0.030). The results of the validation group were in consistence with the primary group. Conclusions: Hematological parameters of
MLR and PDW can be used as an adjuvant tool for the diagnosis of EEC. Moreover, the value of
MLR can reflect the invasion depth index.