D-二聚体FDP和PLT与上皮性卵巢癌预后的相关性分析

Correlation analysis between plasma D-dimer,fibrinogen,platelet levels,and prognosis of patients with epithelial ovarian cancer

目的探讨D-二聚体、纤维蛋白降解产物(FDP)和血小板(PLT)计数与上皮性卵巢癌(EOC)预后的相关性。方法收集2012年10月至2016年6月安徽医科大学第一附属医院妇产科手术治疗的EOC患者196例的临床资料进行回顾性分析,其外周静脉血PLT、FDP和D-二聚体数值为术前留取,对比不同水平D-二聚体、FDP和PLT情况下患者临床(年龄、手术方式、化疗率)及病理情况(分化程度、病理分期),并对比不同止凝血指标水平下患者的生存情况(总生存时间和无瘤生存时间)。结果EOC晚期(Ⅲ~Ⅳ期)患者D-二聚体、FDP、PLT水平高于EOC早期(Ⅰ~Ⅱ期)患者(P <0. 05)。低分化EOC患者FDP、PLT水平高于中高分化EOC患者。D-二聚体和FDP阳性组(D-二聚体> 0. 5 mg/L,FDP> 5 g/L)患者的累计生存率低于D-二聚体和FDP阴性组(D-二聚体≤0. 5 mg/L,FDP≤5 g/L)的患者(P <0. 05),高D-二聚体和FDP水平EOC患者预后较差。PLT> 350×109的卵巢癌与PLT≤350×109/L的卵巢癌患者生存情况差异无统计学意义(P> 0. 05)。结论 EOC晚期患者D-二聚体、FDP和PLT较早期患者升高,D-二聚体及FDP高水平的EOC患者预后不佳,其检测可能有助于识别卵巢癌复发高危人群、评估预后、指导临床决策。

Objective To evaluate the prognostic value of pretreatment plasma dimerized plasmin fragment D （D-dimer）, fibrinogen, and platelet levels in epithelial ovarian cancer （EOC） to screen out the patients with the greatest risk for poor prognosis. Methods The study comprised 196 patients with EOC who had operation in the Department of Gynecology and Obstetrics, the First Affiliated Hospital of Anhui Medical University, then the clinical data were collected and analyzed. The plasma D-dimer, fibrinogen, and platelet levels were examined before treatment and the clinical status （age, surgical method, chemotherapy rate） and pathological status （differentiation degree, pathological stage） of patients with different levels of D-dimer, fibrinogen, and platelet levels were compared, then the clinicopathological parameters, overall survival （OS）, and tumor-free survival （TFS） in patients were assessed. The survival analysis was performed using the Kaplan-Meier method, and prognostic factors were assessed using the Cox proportional hazards regression model. Results Compared with ovarian cancer I-Ⅱ, D -dimer, FDP, PLT levels were significantly higher than those in ovarian cancer Ⅲ-Ⅳ, and the difference was statistically significant（ P 〈0.05） . The FDP, PLT level of patients with low differentiated ovarian cancer was higher than that with high differentiated degree. The cumulative survival rate of patients in the positive D-dimer group and positive FDP group （D-dimer〉0.5mg/L, FDP〉5 g/L） was lower than that in the negative group （D-dimer≤0.5 mg/L, FDP≤5 g/L, P 〈0.05）, indicating that patients with higher level of D-dimer and FDP may have poor prognosis. There was no statistically significant difference in cumulative survival between those patients with PLT〉350×10 9 /L and PLT≤350×10 9 /L（ P 〉0.05）. Conclusion The levels of D-dimer and FDP in advanced epithelial ovarian cancer patients are higher than those in early stage patients. The recurrence rate of EOC patients with high level D-dimer and FDP is significantly higher, suggesting poor prognosis. The combined use of plasma D-dimer, fibrinogen, and platelet levels may help to identify the high-risk population, evaluate the prognosis and guide clinical decision-making.