| Objective:In recent years, the morbidity and mortality of lung cancer were rising and maintained at the first of malignancies. As a pathological type of lung cancer, Small cell lung cancer(SCLC) was poorly differentiated, short doubling time and the highest degree of malignancy. SCLC could occur early and the prognosis of SCLC was poor. How to prolong the survival time of SCLC patients was a problem which researchers and medical professionals need to solve. Some studies had shown that cancer patients often accompanied with hypercoagulable state,and as a common complication of malignancy, hypercoagulable state and thromboembolic disease had leapt to the second cause of death in cancer patients. Hypercoagulable state was not only a potential risk factor for occurred of thromboembolic diseases and DIC, but also had a significant impact on tumor growth, recurrence, metastasis, angiogenesis promotion and so on. Abnormal coagulation parameters were closely related to a variety of malignant tumors’ shorter survival time. So, how to identify hypercoagulable states in early course of cancer patients and intervene with abnormal coagulation had became serious problems which need to solve in clinical work. Some studies had demonstrated that coagulation parameters were closely related to prognosis of NSCLC patients, but reports of coagulation effected on the survival of SCLC patients were relatively few. This study was designed to analyze the relationship between coagulation(D-dimer、FDP、FIB、PT、TT、APTT、PLT) and carcino-embryonic antigen(CEA) with survival time of SCLC patients, to provide theoretical basis for prognosis judgment and early clinical interventions.Methods:To retrospective analysis the clinical data of our oncology department admitted 78 cases of SCLC patients from December 2008 to December 2011. On the basis of sex, age, clinical stage, KPS scores, coagulation indexes(D-dimer、FDP、FIB、PT、TT、APTT、PLT)and CEA levels, 78 cases of SCLC patients were divided into different groups. 78 cases of healthy people in our hospital in the same period was control group. Followed up the survival time of patients, analyzed the relationship between coagulation parameters and CEA levels with biological characteristics of SCLC patients, and analyzed prognostic factors of those patients. Applied normality test of SPSS 17.0 statistical analysis software to distinguish distribution of measurement data, t test to examine the normal distribution, Wilcoxon test to examine the abnormal distribution, ?2 test or Fisher’s probabilities to analyze count date, Kaplan-Meier method to calculate the survival rate, Log rank test to compare the difference survival rate between groups, and Cox proportional hazards regression model was used for multivariate prognosis analysis. All parameters as P <0.05 was considered statistically significant.Results:1. Coagulation, CEA of SCLC patients and control group compared: D-dimer, FDP, FIB, PT, APTT, PLT and CEA levels in SCLC patients were significantly higher, TT levels were significantly lower than the control group, and the difference was statistically significant(all P <0.05).2. The relationship between coagulation indicators and CEA with biological characteristics: In different genders and ages controls, those coagulation indicators and CEA levels were not significantly different. FIB levels in SCLC patients of age≥60 years were higher than the age <60 years old patients, and the difference was statistically significant(P <0.05); however, in different ages patients, D-dimer, FDP, PT, TT, APTT, PLT and CEA levels were not significantly different. D-dimer, FIB and CEA levels in SCLC patients of extensive disease were higher than those levels in patients of limited disease, and the differences were statistically significant(all P <0.05); however, in patients with different clinical stages, FDP, PT, TT, APTT and PLT levels were not significantly different. In different SCLC groups of different sex and KPS scores, those coagulation indicators and CEA levels were not significantly different.3. Single factors survival analysis of SCLC patients: In different gender, age, FDP, PT, TT, APTT and PLT levels groups of SCLC patients, the different of survival time was not statistically significant. However, survival time of SCLC patients in extensive disease, KPS scores <70 points, D-dimer, FIB and CEA higher levels shortened, and the differences were statistically significant(all P <0.05).4. Multivariate survival analysis of SCLC patients: Multivariate analyzed five meaningful single factors above clinical stages, KPS scores, D-dimer, FIB and CEA levels, we could draw a conclusion that D-dimer levels and clinical stages were independent factors for survival in SCLC patients.5. D-dimer and survival time stratified analysis of SCLC patients: According to different sex stratification, the median survival time(MST) of elevated D-dimer groups shortened, and the difference was statistically significant(P <0.05). According to different age stratification, in age<60 years old patients, the MST of elevated D-dimer groups shortened, and the difference was statistically significant(P <0.05); in age≥60 years old patients, the MST between different D-dimer levels groups was not statistically different. According to different clinical stages stratification, in patients with limited disease, the MST of elevated D-dimer groups shortened, and the difference was statistically significant(P <0.05); in patients with extensive disease, the MST between different D-dimer levels groups was not statistically different. According to different KPS scores stratification, in patients with KPS scores ≥70 points, the MST of elevated D-dimer groups significantly shortened, and the difference was statistically significant(P <0.001); in patients with KPS scores <70 points, the MST between different D-dimer levels groups was not statistically different.Conclusion:1. The survival time of SCLC patients in D-dimer, FIB, CEA elevated levels significantly shortened.2. In addition to clinical stages, D-dimer levels can also be used as an independent prognostic factor in SCLC patients,especially for SCLC patients whose age <60 years old, KPS scores≥70 points and with limited disease. |
PDF Full Text Request