Prognostic significance of preoperative coagulation assays in patients with non-small cell lung cancer after complete resection

doi:10.3877/cma.j.issn.2095-8773.2015.01.008

Abstract

Abstract:

Objective

To evaluate the correlation between preoperative coagulation assays’ levels and overall survival (OS) in patients with non-small cell lung cancer (NSCLC) after complete resection.

Methods

A retrospective study of 754 patients with NSCLC undergoing complete resection was conducted at the Tianjin Medical University Cancer Institute and Hospital from January 2004 to December 2008. The correlation of preoperative coagulation assays’ levels with other variables was evaluated by Kruskall-Wallis and Mann-Whitney U test. Univariate and multivariate analysis was employed to determine the association between the preoperative level of coagulation factors and OS.

Results

All preoperative coagulation tests’ levels prothrombin time (PT); international normalized ratio (INR); activated partial thromboplastin time (APTT); thrombin time (TT); fibrinogen (Fbg); D-dimer)were associated with T stage and clinical stage. Univariate analysis of survival showed that preoperative prolonged prothrombin time (PT) (χ²=8.254, P=0.004) and International Normalized Ratio (INR) (χ²=5.404, P=0.020), and abnormally elevated fibrinogen (Fbg) (χ²=9.184, P=0.002) and D-dimer (χ²=9.184, P=0.002) were associated with a poor prognosis. And the multivariate model confirmed preoperative D-dimer was an independent prognostic factor for the patients with NSCLC(OR=1.274, 95%CI: 1.040-1.559, P=0.019).

Conclusions

Preoperative prolongation of PT and INR, and elevation of Fbg and D-dimer are associated with decreased survival in NSCLC patients, and preoperative plasma D-dimer level is an independent prognostic factor of survival in patients with NSCLC after complete resection.

Key words: Cancer, non-small cell lung, Prognosis, D-dimer

Haijin Suo, Hua Zhang, Jianquan Zhu, Jun Liu, Changli Wang. Prognostic significance of preoperative coagulation assays in patients with non-small cell lung cancer after complete resection[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2015, 02(01): 40-47.

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References 31

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变量	总例数	中位值(区间)或频数
年龄(岁)	754	61(24～84)
性别(男/女，例)	754	508/246
吸烟史(是/否，例)	754	494/260
手术类型(全肺切除术/肺叶切除术，例)	754	651/103
肿瘤大体位置(周围型/中心型，例)	754	535/219
病理类型(鳞癌/腺癌/腺鳞癌/大细胞癌/其他，例)	754	373/287/48/10/36
肿瘤部位(左/右，例)	754	311/443
病理分期(ⅠA/ⅠB/ⅡA/ⅡB/ⅢA，例)	754	171/154/116/40/273
T分期(T1/T2/T3/T4，例)	754	283/403/62/6
N分期(N0/N1/N2，例)	754	418/68/268
化疗与否(是/否，例)	754	388/366
血红蛋白(g/L)	751	139(75～268)
白细胞(×10₆/L)	751	6860(3050～24940)
中性粒细胞(×10₆/L)	744	4100(850～15520)
单核细胞(×10₆/L)	749	530(10～2860)
淋巴细胞(×10₆/L)	749	1890(530～2171)
乳酸脱氢酶(IU/L)	750	174(20～738)
碱性磷酸酶(IU/L)	752	71(15～240)

变量	总例数	中位值(区间)或频数
年龄(岁)	754	61(24～84)
性别(男/女，例)	754	508/246
吸烟史(是/否，例)	754	494/260
手术类型(全肺切除术/肺叶切除术，例)	754	651/103
肿瘤大体位置(周围型/中心型，例)	754	535/219
病理类型(鳞癌/腺癌/腺鳞癌/大细胞癌/其他，例)	754	373/287/48/10/36
肿瘤部位(左/右，例)	754	311/443
病理分期(ⅠA/ⅠB/ⅡA/ⅡB/ⅢA，例)	754	171/154/116/40/273
T分期(T1/T2/T3/T4，例)	754	283/403/62/6
N分期(N0/N1/N2，例)	754	418/68/268
化疗与否(是/否，例)	754	388/366
血红蛋白(g/L)	751	139(75～268)
白细胞(×10₆/L)	751	6860(3050～24940)
中性粒细胞(×10₆/L)	744	4100(850～15520)
单核细胞(×10₆/L)	749	530(10～2860)
淋巴细胞(×10₆/L)	749	1890(530～2171)
乳酸脱氢酶(IU/L)	750	174(20～738)
碱性磷酸酶(IU/L)	752	71(15～240)

变量	总例数	正常值范围	中位值(区间)	正常/降低/升高(例数)
PLT(×10⁹/L)	751	100～300	240(50～639)	583/4/164
PT(s)	754	8～14	10.6(8.7～14.8)	753/0/1
INR	754	0.7～1.3	1.0(0.8～1.3)	753/0/1
APTT(s)	754	27～37	26.4(15.3～49.0)	325/412/17
TT(s)	754	14～20	15.4(10.3～28.2)	636/101/17
Fbg(g/L)	754	2～4	3.6(1.4～6.2)	464/11/279
D-二聚体(μg/L)	735	0～500	100(100～3000)	682/0/53

变量	总例数	正常值范围	中位值(区间)	正常/降低/升高(例数)
PLT(×10⁹/L)	751	100～300	240(50～639)	583/4/164
PT(s)	754	8～14	10.6(8.7～14.8)	753/0/1
INR	754	0.7～1.3	1.0(0.8～1.3)	753/0/1
APTT(s)	754	27～37	26.4(15.3～49.0)	325/412/17
TT(s)	754	14～20	15.4(10.3～28.2)	636/101/17
Fbg(g/L)	754	2～4	3.6(1.4～6.2)	464/11/279
D-二聚体(μg/L)	735	0～500	100(100～3000)	682/0/53

变量		PT(s)	INR	APTT(s)	TT(s)	Fbg(g/L)	D-二聚体(μg/L)	PLT(×10⁹/L)
年龄		?	?	?	?	?	?	?
?	≤61岁	10.5	0.950	26.40	15.6	3.424	190	245
?	>61岁	10.7	0.960	26.40	15.4	3.807	192	235
?	χ²值	5.305	4.710	0.006	3.175	6.062	0.001	1.194
?	P值	0.058	0.048	0.690	0.212	0.001	0.820	0.072
性别		?	?	?	?	?	?	?
?	男性	10.6	0.955	26.70	15.7	3.807	197	243
?	女性	10.5	0.950	25.75	15.5	3.360	178	236
?	χ²值	10.276	0.274	4.300	0.227	19.426	2.052	0.059
?	P值	0.009	0.176	0.018	0.155	0.001	0.063	0.357
吸烟史		?	?	?	?	?	?	?
?	否	10.5	0.950	25.95	15.4	3.258	171	231
?	是	10.6	0.960	26.70	15.4	3.879	201	244
?	χ²值	0.077	0.429	3.004	0.197	32.633	1.205	0.226
?	P值	0.085	0.511	0.073	0.829	0.001	0.150	0.058
病理类型		?	?	?	?	?	?	?
?	鳞癌	10.7	0.970	27.10	15.4	4.000	206	248
?	腺癌	10.4	0.940	25.60	15.6	3.109	172	227
?	其他	10.6	0.960	27.05	15.3	3.954	192	254
?	χ²值	15.277	14.207	17.410	1.856	70.680	10.480	14.465
?	P值	0.000	0.001	0.000	0.511	0.000	0.003	0.000
肿瘤大体位置		?	?	?	?	?	?	?
?	周围型	10.5	0.950	26.30	15.5	3.424	192	230
?	中心型	10.7	0.970	26.90	15.2	4.031	189	265
?	χ²值	4.244	5.012	2.681	3.639	25.581	2.417	5.180
?	P值	0.034	0.010	0.032	0.004	<0.001	0.230	0.000
肿瘤部位		?	?	?	?	?	?	?
?	左侧	10.6	0.950	26.20	15.4	3.606	196	239
?	右侧	10.5	0.950	26.60	15.4	3.606	188	242
?	χ²值	0.002	0.045	0.478	0.170	0.045	0.067	0.967
?	P值	0.729	0.821	0.483	0.603	0.820	0.934	0.934
T分期		?	?	?	?	?	?	?
?	T1	10.4	0.940	25.50	15.7	3.208	173	227
?	T2	10.7	0.970	26.90	15.3	3.878	194	243
?	T3-4	11.1	1.010	28.45	15.3	4.564	251	284
?	χ²值	36.927	39.135	33.285	15.326	75.777	17.747	33.256
?	P值	0.001	0.000	0.000	0.001	0.000	0.001	0.000
淋巴结转移		?	?	?	?	?	?	?
?	否	10.5	0.950	26.40	15.4	3.543	173	240
?	是	10.6	0.960	26.45	15.4	3.716	214	241
?	χ²值	2.277	1.122	0.017	0.022	0.833	1.230	1.520
?	P值	0.115	0.045	0.645	0.718	0.423	0.120	0.544
病理分期		?	?	?	?	?	?	?
?	Ⅰ	10.4	0.940	25.90	15.6	3.367	171	230
?	Ⅱ	10.7	0.970	27.35	15.3	4.000	190	258
?	ⅢA	10.7	0.960	26.70	15.4	3.738	237	245
?	χ²值	11.310	9.488	12.626	7.675	26.714	6.299	16.639
?	P值	0.000	0.000	0.000	0.000	0.000	0.002	0.003
血红蛋白(g/L)		?	?	?	?	?	?	?
?	降低(<120)	10.8	0.970	29.00	15.45	3.978	196	292
?	正常(≥120)	10.5	0.950	26.30	15.40	3.606	191	238
?	χ²值	7.322	13.693	7.255	0.045	3.472	1.152	30.152
?	P值	0.001	0.000	0.000	0.485	0.024	0.157	0.000
乳酸脱氢酶(IU/L)		?	?	?	?	?	?	?
?	正常(≤240)	10.6	0.950	26.40	15.4	3.543	189	240
?	升高(>240)	10.6	0.970	26.30	15.2	4.372	219	247
变量		PT(s)	INR	APTT(s)	TT(s)	Fbg(g/L)	D-二聚体(μg/L)	PLT(×10⁹/L)
?	χ²值	0.004	0.609	0.006	0.605	13.518	3.664	0.007
?	P值	0.33	0.277	0.409	0.831	0.000	0.158	0.332
白细胞计数(×10⁶/L)		?	?	?	?	?	?	?
?	正常(≤10000)	10.5	0.950	26.30	15.4	3.483	192	235
?	升高(>10000)	11.0	0.990	27.50	15.2	4.681	187	291
?	χ²值	12.885	14.329	5.607	0，852	34.512	0.089	37.983
?	P值	0.000	0.000	0.007	0.109	0.000	0.838	0.000

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