The Effect Of Radiotherapy On The Levels Of Fibrinogen And Ddimer With Nasopharyngeal Carcinoma And Its Clinical Significance

Nasopharyngeal carcinoma(NPC) originated from nasopharyngeal mucosal epithelium. It is one of the most common head and neck neoplasms, whose characteristics are significantly different from other head and neck cancers. Nasopharyngeal carcinoma has a unique ethnic and geographical distribution that the incidence is very low in most parts of the world(less than 1/10,000 person-year), while in the south of China, Southeast Asia, the Arctic, the Middle East and North Africa, the incidence rate of up to 50/10,000 person-year, and incidence rate of male is about 2-3 times of female[1]. Now it is clear that nasopharyngeal carcinoma is associated with Epstein-Barr Virus(EBV) infection, and the patients have persistence of chronic inflammation. Nasopharyngeal cancer is in the deep space adjuvant to many important tissues and organs, with no specific clinical symptoms, so that early diagnosis is difficult and most of new cases are local advanced nasopharyngeal carcinomas who always have poor survival quality.Early studies have shown that there are complex linkages between cancer and blood coagulation system and fibrinolysis system, and the risk of thrombosis is high in cancer patients. Armand Trousseau is the first one proposed that thrombotic disease is a sign of malignant neoplasm [2]. Today, people come to realize that thrombosis of cancer patients is related to tumor biological characteristics and various treatments effect coagulation process in pathophysiology [3,4]. Fibrinogen(FIB) and D-dimer(D-D) are two sensitive coagulation markers in clinical practice, whose levels are closely related to progress and prognosis for nasopharyngeal carcinoma.Nasopharyngeal carcinoma has a higher sensitivity to radiation therapy which is the main standardized treatment, and radiotherapy combined with chemotherapy is necessary for patients with advanced stages, but the ways of chemotherapies administered are controversial. Currently, with the improvement and promotion of radiotherapy technology, intensity modulated radiation therapy(IMRT) is becoming the main treatment of nasopharyngeal carcinoma patients. Radiotherapy can impair endothelial function, change the blood flow dynamics and blood components, which contribute to the increased risk of thrombosis[5]. At present, there is few relevant study on the impact of radiotherapy on NPC patients’ coagulation status at home and abroad, and the results are controversial. ObjectiveBy exploring the impact of plasma levels of fibrinogen and D-dimer in NPC patients after radiotherapy, this study mainly analyzes the relationship between the changes of coagulation functions and clinical stage and prognosis, and discusses the value of blood coagulation indexs to direct clinical treatment and judge prognosis. Materials and methodsCollecting 96 nasopharyngeal carcinoma patients(male72, female 24, aged 25 to 71 years, mean age 47 years) who were first time diagnosed and without any distant metastasis from July 2014 to September 2015 in Department of Radiotherapy of the First Affiliated Hospital of Zhengzhou University. 51 healthy volunteers were randomly selected from healthy outpatient medical center as control group. All patients were treated by intensity modulated radiation therapy. All patients enrolled were examined the levels of plasma FIB and D-dimer before radiotherapy, both 1 and 3 months after radiotherapy. Plasma levels of FIB and D- dimer were measured by means of threshold method and immunoturbidimetric method. Analyze the differences of coagulation indexes in terms of age, sex, clinical stage of NPC patients before and after radiotherapy, and the relationship with recent curative efficacy. SPSS 21.0 software was used to analyse variability and correlation. Difference of measurement datas was compared with the T-test and single factor analysis of variance. Qualitative datas were compared with the χ2 test. Fisher’s exact test was used for analysis of recent curative efficacy. And P <0.05 was considered as statistically significant. Results1. The plasma levels of FIB and D-dimer of NPC patients before radiotherapy were significantly higher than those of control group(P <0.05);2. There was no statistical differences comparatively among NPC patients before radiotherapy, 1 and 3 months after radiotherapy at sex(P>0.05). FIB and D-dimer levels of age ≥50 years cases higher than those aged <50 years group, the difference was statistically significant(P<0.05); Levels of FIB and D-dimer in clinical stageⅠ~Ⅱ group were lower than those in clinical stage Ⅲ~Ⅳa NPC patients, the difference was statistically significant(P<0.05).3. Comparison the levels of FIB and D-dimer with nasopharyngeal carcinoma before radiotherapy, 1 and 3 months after radiotherapy. The serum FIB concentration after radiotherapy was higher than before radiotherapy and 3 months after radiotherapy(P<0.05), and the level of FIB after radiotherapy 3 months was increased compared with before radiotherapy, the difference was statistically significant(P <0.05); as for the level of D-dimer, after radiotherapy a month, D-dimer level was lower than before radiotherapy, the level after radiotherapy three months was higher than before radiotherapy, the difference was statistically significant(P <0.05).4. Reviewing after the end of treatment within 3 months, 87 cases were effective except for 9 cases. 72 males( effective 65 cases, 7 cases), female 24 cases( effective in 22 cases, 2 cases), the effective rate was no significant difference(P> 0.05); Age ≥50 years old 45 cases( effective in 39 cases, 6 cases), age <50 years old in 51 cases(effective in 48 cases, 3 cases, the short-term efficiency difference was statistically significant(P <0.05). High D-dimer group(>0.3ug/ml)65 cases(effective in 56 cases, 9 cases, normal D-dimer group(≤0.3ug/ml)31 cases(effective in 31 cases, 0 cases, the differences between the two groups were statistically significant(P<0.05). High FIB group(>4.0g/L)15 cases(effective in 9 cases, 6 cases, normal D-dimer group(≤4.0g/L)81 cases(effective in 78 cases, 3 cases, the differences were statistically significant(P<0.05). Conclusions1. The levels of FIB and D-dimer in patients with nasopharyngeal carcinoma were higher than control group, showing that NPC patients had hyperviscosity syndrome.2. The plasma FIB and D-dimer levels of NPC patients showed positive relation to age and clinical stage, but not to gender, reflecting tumor load of patients in some degree. The levels of FIB and D-dimer were helpful for judging state of NPC and estimating prognosis and guiding treatment.3. The plasma levels of FIB and D-dimer in one month after radiotherapy changed significantly, showing a distinct tendency of hypercoagulable state.4. Investigating the blood FIB and D-dimer contents could guide the use of anticoagulant therapies during radiotherapy of NPC patients, by improving blood high condensation state and preventing severe complications such as thrombosis and bleeding, which can improve NPC patients’ prognosis and living quality.