治疗前血浆纤维蛋白原及D-二聚体水平联合预测晚期非小细胞肺癌患者预后

Prediction of prognosis in patients with advanced stage of NSCLC by combined plasma fibrinogen and D-dimer levels before treatment

目的通过对晚期(ⅢB-Ⅳ)非小细胞肺癌(NSCLC)患者血浆纤维蛋白原及D-二聚体与患者总生存期(OS)及无进展生存期(PFS)的回顾性分析,探讨血浆纤维蛋白原及D-二聚体水平对于患者预后的影响。方法回顾性分析134例NSCLC患者,根据患者治疗前血浆纤维蛋白原及D-二聚体水平分组,设定血浆纤维蛋白原≤4 g/L,血浆D-二聚体≤500μg/L(FEU)为正常值,两项指标均为正常值者作为低危组,仅有1项高于正常值者为中危组,两者均高于正常值者为高危组。卡方检验及方差分析法分析不同组间临床病理特征,Kaplan-Meier法计算3组间生存率并绘制生存曲线,用Log-rank检验比较组间生存曲线的差异,采用Cox回归模型分析影响患者预后的因素。结果各组间临床病理特征比较差异无统计学意义,高危组较其他组OS及PFS差异均有统计学意义,生存曲线显示高危组患者预后较差。多因素分析显示临床分期(OS:RR=1.846,95%CI 1.150~2.964,P=0.011;PFS:RR=1.762,95%CI 1.190~2.609,P=0.005)及危险程度分组(OS:RR=1.415,95%CI 1.050~1.908,P=0.023;PFS:RR=1.373,95%CI1.070~1.761,P=0.013)是影响晚期NSCLC患者预后的因素。结论晚期NSCLC患者治疗前血浆纤维蛋白原及D-二聚体水平与患者预后密切相关,高纤维蛋白原及D-二聚体水平患者总生存率较低,且是影响预后的独立因素。

Objective To retrospectively analyze the relationship between progression free survival(PFS)and overallsurvival(OS)in patients with non small cell lung cancer(NSCLC),and to detect the influence of plasma fibrinogen and D-dimer levels before treatment in the prognosis of advanced stage(stageⅢB-Ⅳ)of NSCLC.Methods The study comprised134NSCLC patients with clear pathological diagnosis.All patients were grouped by plasma fibrinogen and D-dimer levels before treatment.We set the normal values of fibrinogen as≤4g/L and D-dimer as≤500μg/L(FEU).Patients with norma llevels of fibrinogen and D-dimer were grouped into low risk group,patients with elevated fibrinogen or D-dimer were grouped into median risk group,and patients with both elevated values were grouped into high risk group.Chi-square test and one way ANOVA analysis were used to analyze the clinicopathologic features of different groups.The OS and PFS indifferent groups were analyzed by Kaplan-Meier analysis.Univariate analysis of PFS and OS were conducted.Thenmultivariate analysis was conducted with the Cox regression model in three groups.Results The clinicopathologic featuresshowed no differences between different groups.There were significant differences in OS and PFS between high risk groupand other groups.In the survival curves,the high risk group showed poor prognosis.The result of multivariate analysisshowed that clinical stage(OS:RR=1.846,95%CI1.150-2.964,P=0.011;PFS:RR=1.762,95%CI1.190-2.609,P=0.005)and grouped by fibrinogen and D-dimer(OS:RR=1.415,95%CI1.050-1.908,P=0.023;PFS:RR=1.373,95%CI1.070-1.761,P=0.013)were prognostic factors for patients with NSCLC.Conclusion The plasma fibrinogen and D-dimer levelsbefore treatment are closely related with the prognosis of NSCLC patients.And a high plasma fibrinogen and D-dimer levelsbefore treatment are associated with poor prognosis in advanced stage of NSCLC patients.