| Part 1:Analysis on relationship between coagulation indices and clinical characteristics as well as prognosis of lung cancer patientsPurpose: To investigate the expression level, clinical significance and prognosis relativity of coagulation and fibrinolysis parameters in lung cancer patients in different pathological types.Material and Methods:The information of 141 lung cancer patients admitted to our hospital from December 2007 to April 2012 (100 males and 41 females, average aged 71.5±11.8 years) were collected and reviewed. The control group contained 49 healthy individuals examined physically from December 2007 to April 2012 in our hospital. The differences of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer (D-D) levels, platelet count (PLT), platelet hematocrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) of patients from two groups were analyzed. Patients in two groups were further divided into high coagulation group (FIB> 4.0g/L) and non-hypercoagulable group (FIB≤ 4.0g/L) according to their levels of FIB normal or abnormal.Results: Among 141 lung cancer patients, there were 131 patients with non small cell lung cancer (NSCLC,92 males and 39 females), including 81 patients with adenocarcinoma (ADC,52 males and 29 females), and 50 patients with squamous carcinoma (SQC,40 males and 10 females) and 10 patients with small cell lung cancer (SCLC,8 males and 2 females).49 healthy individuals (45 males and 4 females, average aged 68.8±10.3 years) were served as controls. The plasma levels of FIB, D-D, PT, APTT and PLT in patients with lung cancers were significantly higher than those in patients of control group (P<0.05). Among lung cancer patients, plasma levels of FIB and PLT in high coagulation group were significantly higher than those in non-hypercoagulable group (P<0.05), but plasma levels of PT and D-D were on the contrary, significantly lower (P<0.05). The levels of APTT and FIB in high coagulation group from patients with lung cancers were significantly higher than those in high coagulation group from control group (P<0.05). The levels of PT, APTT, D-D and PDW in non-hypercoagulable group of patients with lung cancers were also significantly higher than those in non-hypercoagulable group of control group (P<0.05). Lung cancer patients with high D-D levels (D-D>0.5mg/L) had significantly shorter survival periods than those with low D-D levels (D-D≤0.5mg/L, (P<0.05). The survival periods for them were 11.13±11.2 months and 18.3±20.8 months, respectively.Conclusion: Lung cancer patients were in the state of hypercoagulability because of the increases in activities of coagulation system and secondary fibrinolysis and the decrease in ability of anticoagulation. Lung cancer patients with high D-D levels might have shorter survival times.Part 2:Efficacy and safety of adjunctive anticoagulation in patients with lung cancer without indication for anticoagulants:a systematic review and meta-analysis.Purpose: Patients with lung cancer are at high risk of venous thromboembolism (VTE), and VTE predicts a poor prognosis. Anticoagulation therefore might be beneficial for these patients. It is not clear whether anticoagulants could improve survival and other outcomes in patients with lung cancer with no indication for anticoagulation.Material and Methods:We searched the Web of Science, Medline, EMBASE and Cochrane databases for relevant studies. Two reviewers evaluated the studies and extracted data independently. The primary outcomes were 1-year survival and incidence of VTE. Pooled risk ratios (RR) were calculated using control as a reference group and significance was determined by the Z test.Results:Nine eligible studies with 2185 participants were included. Anticoagulation showed significant improvement in survival at 1 year (RR 1.18,95% CI 1.06 to 1.32;p=0.004) and at 2 years (RR 1.27,95% CI 1.04 to 1.56;p=0.02), but not at 6 months. Subgroup analysis showed a survival benefit for patients with small cell lung cancer (SCLC) and those with nonadvanced/limited cancer. The incidence of VTE (RR=0.55,95% CI 0.31 to 0.97; p=0.04) and thromboembolic events (RR=0.48,95% CI 0.28 to 0.82;p=0.008) was reduced with anticoagulation. Both vitamin K antagonist (VKA) and subcutaneous heparin increased the risk of haemorrhage, but heparin did not increase the incidence of major bleeding.Conclusions:Anticoagulation showed a survival benefit, especially for those with SCLC and prolonged life expectancy, and reduced the risk of VTE in lung cancer patients with no indication for anticoagulants. Subcutaneous heparin is superior to VKA because of a potentially smaller risk of major bleeding. |
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