血浆D-二聚体水平对胰腺癌分期及化疗效果的预测价值

Predictive value of the plasma D-dimer levels on stage and response to chemotherapy of the pancreatic cancer

    摘要
  • 摘要: 目的:探讨血浆D-二聚体水平对胰腺癌分期及化疗效果的预测价值。
    方法:采用回顾性横断面研究方法。收集2016年12月至2017年5月复旦大学附属肿瘤医院收治的212例胰腺癌患者的临床病理资料。检测患者血浆D-二聚体水平，分析其与临床病理特征、化疗效果的关系。观察指标：(1)患者临床病理特征与治疗前血浆D-二聚体阳性率的关系。(2)化疗效果评价与血浆D-二聚体水平的关系。(3)随访和生存情况。采用电话方式进行随访，随访内容为患者生存情况。随访时间截至2018年1月。计数资料比较采用x2检验。偏态分布的计量资料以M(范围)表示。
    结果:(1)患者临床病理特征与治疗前血浆D-二聚体阳性率的关系：肿瘤TNM分期Ⅰ～ⅡA期、ⅡB期、Ⅲ期、Ⅳ期患者治疗前血浆D-二聚体阳性率分别为18.37%(9/49)、43.64%(24/55)、53.85%(28/52)、80.36%(45/56)，肿瘤分化程度低分化、中高分化患者治疗前血浆D-二聚体阳性率分别为43.59%(17/39)、24.62%(16/65)，上述指标比较，差异均有统计学意义(x2=41.454，4.051，P<0.05)。(2) 化疗效果评价与血浆D-二聚体水平的关系：212例胰腺癌患者中，108例行超声内镜穿刺或肝穿刺明确病理学诊断后，均接受了以吉西他滨为基础的4～6个周期化疗。108例化疗患者中，59例疗效评价为部分缓解或疾病稳定，血浆D-二聚体水平治疗前39例升高(治疗后28例下降)，20例正常；49例患者疗效评价为疾病进展，D-二聚体水平治疗前34例升高(治疗后8例下降)，15例正常。两类疗效患者治疗前血浆D-二聚体水平升高患者比例比较，差异无统计学意义(x2=0.132，P>0.05)；治疗后血浆D-二聚体水平下降患者比例比较，差异有统计学意义(x2=16.929，P<0.05)。(3)随访情况：212例患者均获得治疗后随访，随访时间为3.5～12.0个月，中位随访时间为7.5个月。随访期间，7例患者死亡，205例生存。
    结论:血浆D-二聚体水平与胰腺癌肿瘤TNM分期、肿瘤分化程度及化疗效果密切相关。

     

    Abstract: Objective:To investigate the predictive value of the plasma D-dimer levels on stage and response to chemotherapy of the pancreatic cancer (PC).
    Methods:The retrospective cross-sectional study was conducted. The clinicopathological data of 212 PC patients who were admitted to the Fudan University Shanghai Cancer Center between December 2016 and May 2017 were collected. Plasma D-dimer levels of 212 patients were measured, and relationship between plasma D-dimer levels and clinicopathological features or response to chemotherapy were analyzed. Observation indicators: (1) relationship between clinicopathological features and positive rate of plasma D-dimer before treatment; (2) relationship between response to chemotherapy and plasma D-dimer levels; (3) follow-up and survival situations. Follow-up using telephone interview was performed to detect survival of patients up to January 2018. Comparisons of count data were analyzed using chi-square test. Measurement data with skewed distribution were described as M (range).
    Results:(1) Relationship between clinicopathological features and positive rate of plasma D-dimer before treatment: positive rate of plasma D-dimer before treatment was respectively 18.37%(9/49), 43.64%(24/55), 53.85%(28/52), 80.36%(45/56) in patients with stage Ⅰ-ⅡA, ⅡB, Ⅲ and Ⅳ of TNM staging and 43.59%(17/39), 24.62%(16/65) in patients with low-differentiated tumor and high- and moderate-differentiated tumor, with statistically significantly differences (x2=41.454, 4.051, P<0.05). (2) Relationship between response to chemotherapy and plasma D-dimer levels: of 212 PC patients, 108 received pathological diagnosis by endoscopic ultrasonography or liver puncture, and then underwent 4-6 cycles chemotherapy with gemcitabine. Of 108 patients, response to chemotherapy of 59 patients was partial remission or stable disease, plasma D-dimer level before treatment was increased in 39 patients (28 with reduced plasma D-dimer level after treatment) and normal in 20 patients; response to chemotherapy of 49 patients was progressive disease, plasma D-dimer level before treatment was increased in 34 patients (8 with reduced plasma D-dimer level after treatment) and normal in 15 patients. There was no statistically significant difference in proportion of patients with increased plasma D-dimer level before treatment (x2=0.132, P>0.05), and there was a statistically significant difference in proportion of patients with reduced plasma D-dimer level after treatment (x2=16.929, P<0.05). (3) Follow-up and survival situations: 212 patients were followed up for 3.5-12.0 months, with a median time of 7.5 months. During the follow-up, 7 patients died and 205 had survival.
    Conclusions:The plasma D-dimer level is significantly associated with TNM staging of the PC, tumor differentiation and response to chemotherapy.

     

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