术前血小板、血浆纤维蛋白原及D-二聚体水平与小细胞肺癌预后的相关性分析
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摘要
目的:回顾性分析术前血小板(platelet,PLT)、血浆纤维蛋白原(fibrinogen,Fib)及D-二聚体(Ddimer,D-D)水平对小细胞肺癌(SCLC)患者预后的影响。方法:选取2005年1月至2017年12月在中日友好医院初次就诊的57例SCLC患者术前血小板、血浆纤维蛋白原及D-二聚体等指标,所有患者均经组织病理学确诊。采用SPSS 25. 0统计软件对相关临床病理因素及生存期进行分析。结果:术前血小板、血浆纤维蛋白原及D-二聚体水平升高的发生率分别为7. 0%、31. 6%、19. 3%,术前血小板和/或血浆纤维蛋白原和/或D-二聚体水平升高的SCLC患者术后生存期有下降趋势。单因素分析提示,卡氏评分(P=0. 038)、TNM分期(P=0. 001)、淋巴结转移(P=0. 049)及术前D-二聚体水平(P=0. 003)均与SCLC预后相关;多因素分析提示,TNM分期(P=0. 005)、术前D-二聚体水平(P=0. 021)为SCLC的独立预后因素,TNM分期为Ⅲ期、术前D-二聚体水平升高的SCLC患者预后较差。结论:术前伴有高血凝状态的SCLC患者预后较差,术前D-二聚体水平测定可作为SCLC预后预测的潜在指标,具有一定的临床意义。
Objective:To retrospectively analyze the prognostic value of pretreatment platelet,plasma fibrinogen and D-dimer levels in SCLC.Methods:Fifty seven patients with pathological-proven SCLC who underwent complete resection between January 2005 and December 2017 were included in this study.Blood samples for pretreatment platelet,fibrinogen and D-dimer examinations were collected.Platelet,fibrinogen and D-dimer levels were analyzed with patients' clinical parameters by SPSS 25.0 software.Results:The overall prevalence of thrombocytosis(>350×10~9/L) was 7.0%,the hyperfibrinogenemia(>4 g/L) was 31.6%,and that of hyper D-dimer(>0.5 mg/L) was 19.3%.Patients with thrombocytosis and/or hyperfibrinogenemia and/or hyper D-dimer exhibited poor overall survival.In univariate analysis,karnofsky performance status(P=0.038),TNM stage(P=0.001),lymphatic metastasis(P=0.049) and pretreatment D-dimer levels(P=0.003) were the considered prognostic factors affecting the survival rate of SCLC patients.The multivariate survival analysis using the Cox model demonstrated that TNM stage(P=0.005) and pretreatment D-dimer levels(P=0.021) were independent prognostic factors of SCLC.The prognosis of SCLC patients with pathological stage Ⅲ and preoperative D-dimer increase was poor.Conclusion:The prognosis of SCLC patients with hypercoagulable state before operation is poor.Elevated pretreatment D-dimer level can be used as a potential indicator for prognosis of SCLC.
Objective:To retrospectively analyze the prognostic value of pretreatment platelet,plasma fibrinogen and D-dimer levels in SCLC.Methods:Fifty seven patients with pathological-proven SCLC who underwent complete resection between January 2005 and December 2017 were included in this study.Blood samples for pretreatment platelet,fibrinogen and D-dimer examinations were collected.Platelet,fibrinogen and D-dimer levels were analyzed with patients' clinical parameters by SPSS 25.0 software.Results:The overall prevalence of thrombocytosis(>350×10~9/L) was 7.0%,the hyperfibrinogenemia(>4 g/L) was 31.6%,and that of hyper D-dimer(>0.5 mg/L) was 19.3%.Patients with thrombocytosis and/or hyperfibrinogenemia and/or hyper D-dimer exhibited poor overall survival.In univariate analysis,karnofsky performance status(P=0.038),TNM stage(P=0.001),lymphatic metastasis(P=0.049) and pretreatment D-dimer levels(P=0.003) were the considered prognostic factors affecting the survival rate of SCLC patients.The multivariate survival analysis using the Cox model demonstrated that TNM stage(P=0.005) and pretreatment D-dimer levels(P=0.021) were independent prognostic factors of SCLC.The prognosis of SCLC patients with pathological stage Ⅲ and preoperative D-dimer increase was poor.Conclusion:The prognosis of SCLC patients with hypercoagulable state before operation is poor.Elevated pretreatment D-dimer level can be used as a potential indicator for prognosis of SCLC.
引文
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[21] Li W,Tang Y,Song Y,et al.Prognostic role of pretreatment plasma D-dimer in patients with solid tumors:A systematic review and Meta-analysis[J].Cellular Physiology & Biochemistry International Journal of Experimental Cellular Physiology Biochemistry & Pharmacology,2018,45(4):1663.
[2] Rao XD,Zhang H,Xu ZS,et al.Poor prognostic role of the pretreatment platelet counts in colorectal cancer:A Meta-analysis[J].Medicine,2018,97(23):e10831.
[3] Zhang SS,Lei YY,Cai XL,et al.Preoperative serum fibrinogen is an independent prognostic factor inoperable esophageal cancer[J].Oncotarget,2016,7(18):25461-25469.
[4] Kaseda K,Asakura K,Kazama A,et al.Prognostic significance of preoperative plasma D-dimer level in patients with surgically resected clinical stage I non-small cell lung cancer:A retrospective cohort study[J].Journal of Cardiothoracic Surgery,2017,12:102.
[5] Van den Berg YW,Osanto S,Reitsma PH,et al.The relationship between tissue factor and cancer progression:Insights from bench and bedside[J].Blood,2012,119(4):924-932.
[6] Wang C,Peng WR,Wang XW,et al.Detection of tumor coagulation indexes in patients with gastric cancer and their clinical significance[J].Chinese Clinical Oncology,2017,22(06):531-534.[汪超,彭万仁,王雪委,等.胃癌患者凝血指标检测及临床意义[J].临床肿瘤学杂志,2017,22(06):531-534.]
[7] Wu HJ,Zou XM.Progress of gastric cancer and coagulation function[J].International Journal of Surgery,2016,43(1):70-72.[吴红杰,邹小明.胃癌与凝血功能的研究进展[J].国际外科学杂志,2016,43(1):70-72.]
[8] Ma YC,Zhang H,Zhang B,et al.Prognostic value of pretreatment platelet and fibrinogen levels for early non-small cell lung cancer after complete resection[J].Chinese Journal of Clinical Oncology,2018,45(05):222-227.[马宇辰,张华,张彬,等.术前血小板及血浆纤维蛋白原对早期非小细胞肺癌的预后价值[J].中国肿瘤临床,2018,45(05):222-227.]
[9] Wang L,Zhou W,Zhang J,et al.Application value of D-dimer in evaluating metastasis and prognosis of non-small cell lung cancer[J].Chinese Journal of Clinical Laboratory Science,2017,35(04):288-290.[王琳,周芸,张杰,等.D-二聚体在评估非小细胞肺癌转移及预后中的应用价值[J].临床检验杂志,2017,35(04):288-290.]
[10] Goubran HA,Stakiw J,Radosevic M,et al.Platelet-cancer interactions[J].Semin Thromb Hemost,2014,40(03):296-305.
[11] Craioto-Villanueva A,Luna-Perez P,Gutierrez-de la Barrera M,et al.Thrombocytosis as a predictor of distant recurrence in patients with rectal cancer[J].Arch Med Res,2012,43(4):305-311.
[12] Li Jingjing,Zhong Chunsheng.Research progress on the correlation of platelets and tumor[J].Modern Oncology,2017,25(23):3896-3900.[李晶晶,钟春生.血小板与肿瘤相关性研究进展[J].现代肿瘤医学,2017,25(23):3896-3900.]
[13] Wang S,Li Z,Xu R.Human cancer and platelet interaction,a potential therapeutic target[J].International Journal of Molecular Sciences,2018,19(4):1246.
[14] Wang YH,Deng SJ,Yang YD,et al.The pretreatment thrombocytosis may predict prognosis of patients with colorectal cancer:A systematic review and Meta-analysis[J].Biomarkers in Medicine,2017,11(2):195-210.
[15] Zhang XJ,Liu YG,Shi XJ,et al.The prognostic role of neutrophils to lymphocytes ratio and platelet count in gastric cancer:A Meta-analysis[J].Int J Surg,2015,21:84-91.
[16] Guillem-Llobat P,Dovizio M,Bruno A,et al.Aspirin prevents colorectal cancer metastasis in mice by splitting the crosstalk between platelets and tumor cells[J].Oncotarget,2016,7:32462-32477.
[17] Lichtenberger LM,Fang D,Bick RJ,et al.Unlocking aspirin's chemopreventive activity:Role of irreversibly inhibiting platelet cyclooxygenase-1[J].Cancer Prev Res,2017,10:142-152.
[18] Johnson KE,Forward JA,Tippy MD,et al.Tamoxifen directly inhibits platelet angiogenic potential and platelet-mediated metastasis[J].Arterioscler Thromb Vasc Biol,2017,37:664-674.
[19] Kolodziejczyk J,Ponczek MB.The role of fibrinogen,fibrin and fibrin(ogen) degradation products(fdps) in tumor progression[J].Contemp Oncol(Pozn),2013,17:113-119.
[20] Shu YJ,Weng H,Bao RF,et al.Clinical and prognostic significance of preoperative plasma hyperfibrinogenemia in gallbladder cancer patients following surgical resection:A retrospective and in vitro study[J].BMC Cancer,2014,14:566.
[21] Li W,Tang Y,Song Y,et al.Prognostic role of pretreatment plasma D-dimer in patients with solid tumors:A systematic review and Meta-analysis[J].Cellular Physiology & Biochemistry International Journal of Experimental Cellular Physiology Biochemistry & Pharmacology,2018,45(4):1663.