Risk Analysis Of Severe Thrombocytopenia In Nasopharyngeal Carcinoma During Concurrent Chemoradiotherapy

Objective:To explore the risk factors and predictors of severe thromb-ocytopenia(TP)in nasopharyngeal carcinoma(NPC)during concurrent chemoradi-otherapy.Methods:To collect patients with NPC treated in the Department of Oncology,second affiliated Hospital of Nanchang University from August 2014 to July 2017.Patients with the lowest platelet count?50×10~9/L during concurrent chemoradiotherapy were included in the observation group,and patients with the lowest platelet count>100×10~9/L were included in the control group according to the 1:1 ratio.Record general data of patients,laboratory examination of first visit,pre-radiotherapy,and radiotherapy.To explore the risk factors and independent predictive factors of severe TP during concurrent chemoradiotherapy of NPC by univariate and multivariate regression analysis.The ROC was used to evaluate the prognostic value of various factors for severe TP in NPC during concurrent chemoradiotherapy and to select the best truncation value.Results:The observation group and the control group each included 40 patients.Univariate regression analysis showed that many factors have statistical significance,include Age(OR=0.912,95%CI0.865-0.963,P=0.001),PLT(OR=1.021,95%CI1.010-1.033,P<0.001)at first visit,IBIL(OR=0.863,95%CI 0.767-0.970,P=0.013)at first visit,APTT(OR=1.126,95%CI1.023-1.241,P=0.016)at first visit,WBC(OR=1.170,95%CI1.014-1.350,P=0.032),RBC(OR=5.396,95%CI1.970-14.782,P=0.001),HGB(OR=1.031,95%CI1.002-1.060,P=0.034),PLT(OR=1.016,95%CI 1.006-1.027,P=0.003),NEUT(OR=1.172,95%CI1.007-1.364,P=0.041),APTT(OR=1.126,95%CI1.023-1.241,P=0.016),IBIL(OR=0.740,95%CI0.614-0.893,P=0.002),FFA(OR=0.045,95%CI0.030-0.628,P=0.021),Crea(OR=0.970,95%CI0.945-0.995,P=0.018)?Urea(OR=0.751,95%CI 0.565-0.998,P=0.049).But multivariate regression analysis showed that RBC(OR=10.060,95%CI2.679-37.777,P=0.001),PLT(OR=1.020,95%CI1.006-1.034,P=0.005)and IBIL(OR=0.710,95%CI 0.561-0.898,P=0.004)are independent predictors of severe TP in NPC.ROC analysis display,the AUC of RBC is 0.746(P<0.001),which best truncation value is?3.82,have the sensitivity of 70%and specificity of 70%.the AUC of IBIL is 0.735(P<0.001),which best truncation value is>5.87 mmol/L,have the sensitivity of 62.16%and specificity of 82.5%.the AUC of PLT is 0.702(P=0.001),which best truncation value is?144×109/L,have the sensitivity of 57.5%%and specificity of 82.5%.the AUC of age is 0.734(P<0.001),which best truncation value is>48 yeas old,have the sensitivity of 72.5%and specificity of 67.5%.At the same time.New variables calculated by regression equation(Y=2.309*RBC-0.343*IBIL+0.02*PLT-10.007),called joint predictor,the AUC of which is 0.870(P<0.001),and best truncation value is>5.87 mmol/L,which have the sensitivity of 62.16%and specificity of82.5%.Conclusion:1.Lower RBC,lower PLT and higher IBIL are independent risk factors of severe TP in patients with NPC during concurrent chemoradiotherapy.2.RBC,PLT,IBIL and combined prognostic factors before concurrent chemoradio-therapy in NPC have a good predictive value for severe TP.