术前血浆D-二聚体与早期宫颈癌术后复发相关性研究

Association of preoperative plasma D-dimer with recurrence of early cervical cancer

目的宫颈癌FIGO分期存在一定的缺陷,血浆D-二聚体(D-D)水平与肿瘤预后密切相关。本研究探讨术前血浆D-D水平对早期宫颈癌术后复发的影响。方法试验设计属于前瞻性随访研究,以2009-01-01-2012-12-31广州市花都区妇幼保健院诊治的165例早期宫颈癌患者为研究对象。根据术前血浆D-D水平分为D-D升高组和D-D正常组,以电话随访为主,随访终点事件为宫颈癌复发。生存率估算应用Kaplan-Meier法,组间生存率曲线差异采用Log-rank检验,应用多变量Cox比例风险回归分析宫颈癌复发的独立危险因素。结果 D-D升高组67例(40.6%)。D-D正常组和D-D升高组中肿瘤直径≥4cm的比例分别为15.3%和29.9%,χ~2=5.037,P=0.025;淋巴结转移分别为35.7%和55.2%,χ~2=6.158,P=0.013;临床分期Ⅰ/ⅡA分别为47/51和20/47,χ~2=5.411,P=0.020。D-D正常组有11例复发,复发时间中位数为36(15~62)个月,5年无复发生存率为88.8%;D-D升高组有16例复发,复发时间中位数为25.5(6~50)个月,5年无复发生存率为74.0%。Kaplan-Meier生存曲线表明,D-D升高组无复发生存率显著低于D-D正常组,χ~2=4.805,P=0.028。单因素分析显示,组织学类型(HR=1.124,P=0.034)、淋巴结转移(HR=1.589,P=0.016)、FIGO分期(HR=1.854,P=0.007)、D-D水平(HR=1.395,P=0.023)和治疗方法(HR=0.891,P=0.043)为复发的危险因素。多变量Cox比例风险回归分析显示,淋巴结转移(HR=2.116,P=0.012)、FIGO分期(HR=4.421,P=0.001)、D-D水平(HR=2.125,P=0.039)和治疗方法(HR=0.912,P=0.045)是影响宫颈癌复发的独立危险因素。结论术前D-D水平是影响宫颈癌复发的危险因素,有助于更好地指导治疗、判断预后。

OBJECTIVE The FIGO stage of cervical cancer shows a certain defect,and the plasma D-dimer level（D-D）is closely related to tumor prognosis.This paper is to explore the effect of preoperative plasma D-dimer level on recurrence in patients with early cervical cancer.METHODS This study was a prospective follow-up study which included subjects with early cervical cancer treated in Obstetrics and Gynecology department of Affiliated Huaihe Hospital of Henan University between 2009.1.1and 2012.12.31.These subjects were divided into D-D elevated group and D-D normal group according to preoperative plasma D-dimer level.The main form of follow-up was telephone follow-up.Followup endpoint was cancer recurrence.Kaplan-Meier method was used to estimate survival rate.The survival difference between the two groups was compared using the Log-rank test.Multivariate Cox proportional hazards regression were used to determine the independent risk factors of cervical cancer recurrence.RESULTS 67cases（40.6%）showed an elevated D-D level.The ratio of cases with tumor diameter≥4cm,the positive rates of lymph node metastasis andⅠ/ⅡA in D-D normal group and D-D elevated group were 15.3% and 29.9%,χ~2=5.037,P=0.025,35.7% and 55.2%,χ~2=6.158,P=0.013,and 47/51 and 20/47,χ~2=5.411,P=0.020,respectively.11 cases recurred in D-D normal group with a median time of 36（15-62）months and a 5-year recurrence-free survival rate of 88.8%;16cases recurred in D-D elevated group,with a median time of 25.5（6-50）months and a 5-year recurrence-free survival rate of 74.0%.Kaplan-Meier curve shows that recurrence-free survival rate in D-D elevated group was significantly lower than that in D-D normal group（χ~2=4.805,P=0.028）.Univariate analysis showed that histological type（HR=1.124,P=0.034）,lymph node metastasis（HR=1.589,P=0.016）,FIGO stage（HR=1.854,P=0.007）,D-D level（HR=1.395,P=0.023）and treatment method（HR=0.891,P=0.043）were the risk factors of relapse.Multivariate Cox proportional hazards regression analysis showed that lymph node metastasis（HR=2.116,P=0.012）,FIGO stage（HR=4.421,P=0.001）,D-D levels（HR=2.125,P=0.039）and treatment method（HR=0.912,P=0.045）were the independent risk factors for cervical cancer recurrence.CONCLUSION D-dimer level is a risk factor affecting cervical cancer relapse,which helps better guiding treatment and prognosis judgment.