天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (4): 376-380.doi: 10.11958/20161482

• 临床研究 • 上一篇    下一篇

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

史博文， 岳东升， 孙冰生， 张钰， 李晨光， 王长利△   

  1. 天津医科大学肿瘤医院肺部肿瘤科， 国家临床医学研究中心， 天津市肿瘤防治重点实验室， 天津市肺癌诊治中心 （邮编 300060）
  • 收稿日期:2016-12-06 修回日期:2017-03-01 出版日期:2017-04-15 发布日期:2017-04-15
  • 通讯作者: △通讯作者 E-mail: tjzlyysbw@163 E-mail:tjzlyysbw@163.com
  • 作者简介:史博文 （1990）， 男， 硕士在读， 主要从事肿瘤学研究
  • 基金资助:
    天津市抗癌重大科技专项基金资助项目 （12ZCDZSY15400）

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

SHI Bo-wen, YUE Dong-sheng, SUN Bing-sheng, ZHANG Yu, LI Chen-guang, WANG Chang-li△   

  1. Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Lung Cancer Center, Tianjin 300060, China
  • Received:2016-12-06 Revised:2017-03-01 Published:2017-04-15 Online:2017-04-15
  • Contact: △Corresponding Author E-mail： tjzlyysbw@163.com E-mail:tjzlyysbw@163.com

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摘要： 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≤500 μg/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%CI 1.070～1.761， 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。

关键词: 癌, 非小细胞肺, 纤维蛋白原, 预后, 抗肿瘤联合化疗方案, 存活率分析, D-二聚体

Abstract: Objective To retrospectively analyze the relationship between progression free survival (PFS) and overall survival (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 (stage ⅢB-Ⅳ) of NSCLC. Methods The study comprised 134 NSCLC 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 ≤4 g/L and D-dimer as ≤500 μg/L（FEU). Patients with normal levels 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 in different groups were analyzed by Kaplan- Meier analysis. Univariate analysis of PFS and OS were conducted. Then multivariate analysis was conducted with the Cox regression model in three groups. Results The clinicopathologic features showed no differences between different groups. There were significant differences in OS and PFS between high risk group and other groups. In the survival curves, the high risk group showed poor prognosis. The result of multivariate analysis showed that clinical stage (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） and grouped by fibrinogen and D- dimer (OS:RR=1.415， 95% CI 1.050- 1.908， P=0.023； PFS： RR=1.373， 95% CI 1.070- 1.761， P=0.013) were prognostic factors for patients with NSCLC. Conclusion The plasma fibrinogen and D-dimer levels before treatment are closely related with the prognosis of NSCLC patients. And a high plasma fibrinogen and D-dimer levels before treatment are associated with poor prognosis in advanced stage of NSCLC patients.

Key words: carcinoma, non-small-cell lung, fibrinogen, prognosis, antineoplastic combined chemotherapy protocols, survival analysis, D-dimer