术前D-二聚体联合纤维蛋白原对早期宫颈癌术后复发的诊断价值

Diagnostic value of preoperative D-dimers combined with fibrinogen in postoperative recurrence of early cervical cancer

目的探讨术前D-二聚体(DD)联合纤维蛋白原(Fib)对评估早期宫颈癌术后复发的诊断价值。方法回顾性分析2010年1月至2013年1月于杭州市富阳区妇幼保健院行手术切除治疗的48例早期宫颈癌患者的临床资料。根据术前DD/Fib水平(正常值:DD≤0.5mg/L;Fib≤4 g/L)将患者分为低危组(DD/Fib均为正常值)、中危组(任意1项高于正常值)、高危组(2项均高于正常值)。比较三组患者DD/Fib水平与临床病理学资料以及术后复发的关系,并建立COX比例风险回归模型分析早期宫颈癌术后复发的危险因素。结果 48例早期宫颈癌患者中,低危组16例患者,中危组17例患者,高危组15例患者。与低危组、中危组比较,高危组患者肌层侵犯程度更大(χ~2=7.635,P=0.022)、FIGO分期更高(χ~2=6.174,P=0.046)、肿瘤直径更大(χ~2=11.787,P=0.003)、淋巴结转移占比更多(χ~2=8.319,P=0.016)。Kaplan-Meier生存分析显示,低危组患者的无瘤生存率最高(93.3%),中危组患者次之(87.5%),高危组患者最低(38.9%),其差异具有统计学意义(Log-rank χ~2=17.532,P<0.001)。COX单因素分析显示,FIGO分期、肿瘤直径、淋巴结转移、治疗方案、DD/Fib危险度分组与早期宫颈癌术后复发相关(均P<0.05);COX多因素分析显示,FIGO分期(HR=5.286,P=0.033)、治疗方案(HR=0.199,P=0.024)、DD/Fib危险度分组(HR=3.805,P=0.022)是早期宫颈癌术后复发的独立危险因素。结论术前DD联合Fib对早期宫颈癌术后复发具有重要的预测价值。

Objective To evaluate the diagnostic value of preoperative plasma D-dimer(DD)combined with fibrinogen(Fib)in evaluating postoperative recurrence of early cervical cancer.Methods The clinical data of patients with early stage cervical cancer who underwent surgical resection in Maternal and Child Health Hospital,Fuyang District,Hangzhou from January 2010 to January 2013 were retrospectively analyzed.According to preoperative DD/Fib level(normal value:DD=0.5 mg/L;Fib=4 g/L),the patients were divided into low risk group(DD/Fib normal value),middle risk group(any higher than normal value)and high risk group(two items were both above normal value).The relationship among the DD/Fib level,the data and the postoperative recurrence was compared among the three groups,and the risk factors for the recurrence of early cervical cancer were analyzed by a COX proportional risk regression model.Results Among 48 cases of early cervical cancer,16 cases were in low risk group,17 in middle risk group and 15 in high-risk group.Compared with the low risk group and the middle risk group,the degree of myometrium invasion was greater(χ~2=7.635,P=0.022),FIGO staging was higher(χ~2=6.174,P=0.046),and the tumor diameter was larger(χ~2=11.787,P=0.003)in high risk group with more lymph node metastasis(χ~2=8.319,P=0.016).Kaplan-Meier survival analysis showed that the tumor free survival of the low risk group was the highest(93.3%),which was followed by the middle risk group(87.5%),and that of the high risk group was the lowest(38.9%).The difference was statistically significant(Log-rankχ~2=17.532,P<0.001).The result of univariate Cox model analysis showed that the statistically significant prognostic factors were FIGO staging,tumor diameter,lymph node metastasis,therapeutic modalities and DD/Fib risk grouping(all P<0.05).The result of multivariate Cox model analysis showed that the independent prognostic factors were FIGO staging(HR=5.286,P=0.033),therapeutic modalities(HR=0.199,P=0.024)and DD/Fib risk grouping(HR=3.805,P=0.022).Conclusions Preoperative DD combined with Fib has important predictive value for postoperative recurrence of early cervical cancer.