抗凝治疗对中晚期胃癌改善高凝状态、抗肿瘤转移的临床研究

Clinical study of anticoagulant therapy on hypercoagulable state and anti-tumor metastasis in advanced gastric cancer

目的:分析胃癌患者凝血指标与临床病理特征的关系,观察抗凝治疗对高凝状态、肿瘤转移、生存期的影响及安全性评价。方法:选取140例胃癌患者,分析凝血指标与临床病理特征的关系。选取III期胃癌患者172例,分为治疗组(抗凝治疗联合化疗)116例,对照组56例(单用化疗),观察抗凝治疗对高凝状态、肿瘤转移、生存期的影响及安全性评价。结果:淋巴结转移N_(1-3)组较N_0组D-二聚体升高(P<0.05),III、IV期较I、II期血浆纤维蛋白原(FIB)、D-二聚体升高,部分活化凝血活酶时间(APTT)数值降低(P<0.05)。治疗组抗凝治疗后,血浆凝血酶原时间(PT)、APTT延长,D-二聚体、FIB降低(P<0.05)。治疗组的12月、24月、36月腹腔淋巴结、肝脏转移率较对照组降低(P<0.05)。治疗组2年、3年生存率高于对照组(P<0.05),中位生存期及无病生存期较对照组延长。两组牙龈出血、血小板减少、皮肤瘀点瘀斑发生率无统计学差异(P>0.05)。结论:胃癌高凝状态影响因素为淋巴结转移、TNM分期偏晚。抗凝治疗可改善高凝状态,降低腹腔淋巴结及肝脏转移率,延长生存期,未增加上述不良反应发生率。

AIM : To analyze the relationship between coagulation parameters and clinic pathological features of gastric cancer patients, and observe the effect of anticoagulant therapy on hypercoagulable state, tumor metastasis/recurrence, survival status and safety evaluation of gastric cancer. METHODS : 140 patients with gastric cancer were selected to analyze the relationship between coagulation parameters and clinic pathological features. 172 patients with stage III gastric cancer were enrolled, including 116 patients in the treatment group (prophylactic anticoagulant therapy combined with postoperative adjuvant chemotherapy) and 56 patients in the control group (postoperative adjuvant chemotherapy). The anticoagulant therapy was observed on hypercoagulable state and tumor metastasis/recurrence, impact of survival and safety assessment. RESULTS :D-dimer of lymph node metastasis N 1-3 group was higher than N 0 group ( P < 0.05 ), stage III and IV were higher than stage I and II of FIB, D-dimer, and APTT value was decreased ( P < 0.05 ). Before and after anticoagulant therapy in the treatment group, PT and APTT were prolonged, D-dimer and FIB were decreased ( P < 0.05 ). The rate of lymph node and liver metastasis in the treatment group was lower than that in the control group in 12, 24 and 36 months ( P < 0.05 ). The 2-year and 3-year survival rates of the treatment group were higher than those of the control group ( P < 0.05 ), and the median survival and disease-free survival were longer than the control group. There was no significant difference in the incidence of gingival bleeding, thrombocytopenia, and ecchymosis of the skin between the two groups ( P > 0.05 ). CONCLUSION :The factors influencing the hypercoagulable state of gastric cancer are lymph node metastasis and TNM staging. Anticoagulant therapy can improve hypercoagulability, reduce the rate of lymph node and liver metastasis, and prolong survival without increasing the incidence of adverse reactions.