术前凝血检测对于评估根治性非小细胞肺癌患者预后的意义

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

目的评估术前常规凝血功能检测水平与非小细胞肺癌（NSCLC）患者行根治性完整切除术后总生存率的相关性。方法选取2004年1月至2008年12月在天津医科大学肿瘤医院行完全性切除手术的NSCLC患者754例。利用Kruskall-Wallis和Mann-WhitneyU检验，评价术前常规凝血检测水平与其他变量的相关性，并且通过单变量和多变量分析确定凝血功能的术前水平和总体生存率之间的关联。结果所有术前常规凝血检测指标（血浆凝血酶原时间、国际标准化比值、活化部分凝血活酶时间、凝血酶时间、纤维蛋白原、D-二聚体）水平与NSCLC患者T分期及临床分期均存在相关性。单因素分析显示，术前凝血试验巾血浆凝血酶原时间（χ^2=8．254，P=0.004）和国际标准化比值（χ^2=5．4．4，P=0．020）延长，以及异常升高的纤维蛋白原（χ^2=9．184，P=0.002）和D-二聚体（χ^2=9．184，P=0．002）水平提示预后较差。多变量模型证实术前D-二聚体为NSCLC患者预后的独立因素（OR=1．274，95％CI：1．040～1．559，P=0．019）。结论术前凝血检测中血浆凝血酶原时间和国际标准化比值延长以及纤维蛋白原和D-二聚体水平升高提示NSCLC患者预后不良，而术前凝血检测中D-二聚体是行根治性手术NSCLC患者的独立预后因素。

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＇ ievels 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） （χ^2= 8. 254, P= 0. 004） and International Normalized Ratio （INR） （χ^2=5. 404, P=0. 020）, and abnormally elevated fibrinogen （Fbg） （χ^2=9. 184, P=0. 002） and D-direct （χ^2=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 Ddimer are associated with decreased survival in NSCLC patients, and preoperative plasma D-direct level is an independent prognostic factor of survival in patients with NSCLC after complete resection.