凝血功能与肾癌肿瘤分期及转移的相关性研究

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

目的探讨凝血功能与肾癌肿瘤分期及转移的关系。方法回顾性分析我院2011～2012年收治的150例肾癌患者的临床资料。男95例,女55例。平均年龄(51.41±19.68)岁。病理类型:透明细胞癌120例、乳头状癌11例、嫌色细胞癌6例、囊性肾癌8例,其他类型5例。TNM分期:Ⅰ期87例(T1a45例,T1b42例),Ⅱ期24例、Ⅲ期22例、Ⅳ期17例。N0111例、N117例、N222例,M0133例、M117例。病理明确诊断为肾良性肿瘤132例纳入对照组。比较两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(4.08±1.12)g/L,对照组(3.23±0.52)g/L,两组比较差异有统计学意义(P<0.01);肾癌组PT(10.65±1.38)s、APTT(31.11±3.56)s、INR(0.95±0.72),对照组分别为(11.02±7.44)s、(31.24±3.05)s、(0.96±0.64),两组比较差异均无统计学意义(P>0.05)。肾癌5个亚组术前Fib分别为(3.75±0.59)g/L、(3.31±0.64)g/L、(4.34±0.52)g/L、(4.99±0.38)g/L、(6.04±1.06)g/L,其中T1a、T1b组与对照组比较差异无统计学意义(P>0.05),其余组与对照组比较差异有统计学意义(P<0.01)。肾癌组高纤维蛋白原血症(Fib>4.0g/L)者68例(24.1%)。结论肾癌伴淋巴结及远处转移者血清Fib升高,肿瘤分期为Ⅱ期、Ⅲ期、Ⅳ期发生转移的可能性较大。血清Fib对肾癌预后具有独特的预测价值。

Objective To investigate the relationship between coagulation function with tumor stage and metastasis status in patients with renal cell carcinoma （RCC）. Methods Data of 150 cases diagnosed as RCC during 2011 to 2012 were retro- spectively analyzed, including 95 male and 55 female patients. The average age was （51.41±19.68） years. There were 120 ca- ses of clear cell carcinoma, 11 papillary carcinoma, 6 chromophobe cell carcinoma, 8 cystic RCC, and 5 cases of other types. TNM classification showed 87 cases in stage I （T1a 45,Tlb 42）, 24 in stage Ⅱ , 22 in stage Ⅲ, and 17 in stage IV. There were 111 No, 17 Nland 22 N2 cases, 133 M0 and 17 M1 cases. A total of 132 cases of benign renal tumors were taken as controls. Fi- brinogen （Fib）, prothrombin time （PT）, activated partial thromboplastin time （APTT） and international normalized ratio （INR） were detected. Results The preoperative serum Fib of RCC patients and controls were （4.08± 1.12）g/L and （3.23± 0.52）g/L, respectively, with significant difference （P（0.01）. The values of preoperative PT, APTT, and INR were （10.65 ±1.38）s, （31.11±3.56）s, and 0.95±0.72 in RCC patients and （11.02±7.44）s, （31.24±3.05）s, and 0.96±0.64 in the controls, with no significant differences between them （P^0.05）. The values of Fib in stage Tla, Tlb, 11 , HI, and IV groups were （3.75±0.59）g/L, （3.31±0.64）g/L, （4. 34±0.52）g/L, （4.99±0. 38）g/L and （6.04±1.06）g/L, respectively. There was no significant difference between stage Tla, TlbRCC patients and the controls （P〉0.05）. However, results of the other stages showed significant difference with the controls （P〈0.01）. 68 cases （24. 1%） with RCC had Fib〉4.0 g/L, which indi- cated hyperfibrinogenemia. Conclusions Plasma Fib levels could be elevated significantly in RCC patients with distant metas- tasis or lymph node metastasis, indicating a unique predictive value of prognosis in patients with renal cell carcinoma.