肾癌患者凝血功能与肿瘤分期及转移的关系

Correlation of coagulation function to tumor stage and metastasis status in patients with renal cell carcinoma

目的 探讨肾癌患者凝血功能与肿瘤大小、分期及转移之间的关系.方法 2004-2009年连续收治肾癌患者290例.男181例,女109例.平均年龄（56.3±13.5）岁.其中透明细胞癌252例、乳头状癌19例、嫌色细胞癌5例、囊性肾癌3例,其他类型11例.临床分期Ⅰ期202例（T1a 118例,T1b 82例）,Ⅱ期32例,Ⅲ期32例,Ⅳ期24例.N0264例,N1 11例,N2 15例.M0 273例,M1 17例.病理明确诊断为肾良性肿瘤186例作为对照组.比较2组患者术前纤维蛋白原（Fib）、凝血酶原时间（PT）、部分活化凝血酶原时间（APTT）及国际标准化比值（INR）水平.结果 肾癌组患者术前Fib值（39.6±15.6）g/L,对照组（32.8±8.2）g/L,2组比较差异有统计学意义（P〈0.05）;肾癌组PT（11.2±1.3）s、APTT（31.7±5.2）s、INR 1.0±0.1,对照组分别为（11.1±1.3）s、（32.4±4.2）s、1.0±0.1,2组比较差异均无统计学意义（P〉0.05）.肾癌T1a、T1b、Ⅱ、Ⅲ、Ⅳ期组患者Fib分别为（32.6±6.6）、（36.1±8.7）、（48.8±21.6）、（49.9±17.9）、（59.7±19.2）g/L,其中T1a组与对照组比较差异无统计学意义（P=0.88）,其他组与对照组比较差异均有统计学意义（P〈0.01）.肾癌组高纤维蛋白原血症（Fib〉44.0 g/L）者74例（25.5%）,以病理检查为标准,高纤维蛋白原血症预测肿瘤转移的敏感性为60.5%,特异性为80.6%,阳性预测值为35.1%,阴性预测值为92.1%.结论 肾癌伴淋巴结及远处转移者血清Fib升高,肿瘤直径〉4 cm者发生转移的可能性较大.术前Fib水平尤其是高纤维蛋白原血症有助于预测肿瘤转移,并协助制定手术治疗策略.

Objective To investigate the relationship between coagulation function and the tumor size, clinical stage and metastasis status in renal cell carcinoma （RCC） patients. Methods A total of 290 RCC patients from 2004 to 2009 were included in present study. There were 181 male patients and 109 female patients. The average ages was （56.3± 13. 5） years. There were 252 cases of clear cell carcinoma, 19 cases of papillary carcinoma, 5 cases of chromophobe cell carcinoma, 3 cases of cystic RCC, and 11 cases of other types. TNM classification： stage Ⅰ 202 patients, stage Ⅱ32 patients , stage Ⅲ 32 cases, stage Ⅳ 24 cases. There were N0 264 patients, N1 11 patients and N2 15 cases. There were M0 273 cases, M1 17 cases. One hundred and eighty-six cases of benign renal tumors were set as the control group. Fibrinogen （Fib）, prothrombin time （PT）, activated partial thromboplastin time （APTT） and international normalized ratio （INR） were detected. Results The preoperative serum Fib of RCC patients was （39. 6±15.6） g/L, the control group was （32. 8±8. 2）g/L. There was significant difference between them （P〈0. 05）. The values of preoperative APTT,INR, and PT were （31.7±5.2）s, （1.0±0. 1）, （11.2±1.3）s in RCC group and （32. 4±4.2）s,（1.0±0. 1）, （11.1±1.3）s in the control group. There were no significant differences between them （P〈0.05）. The values of Fib in stage Ⅰa, Ⅰb, Ⅱ, Ⅲ, Ⅳ groups were （32. 6±6. 6）, （36. 1±8. 7）,（48.8±21.6）, （49.9± 17.8） and （59.7± 19.2）g/L, respectively. There was no significant difference between stage Ⅰ, and the control group. But the other stages showed significant difference with the control group （P〈0.01）. Hyperfibrinogenemia （Fib〉44.0 g/L） in the RCC group accounted for 74 cases （25.5%）. If the value of Fib ≤44. 0 g/L, 92.1% of patients can be excluded from the probability of metastasis. Conclusions Preoperative plasma Fib levels could be elevated in RCC patients with distant metastasis or lymph node metastasis. Increased preoperative plasma Fib levels, especially hyperfibrinogenemia may be a predictor of metastasis.