| Objective:The thesis is aimed to reveal the changes and relevance to survival of coagulation indies before and after the chemotherapy.Methods:Collect the clinical information of 618 patients with stageⅢb-Ⅳnon-small cell lung cancer(NSCLC)by retrospective analysis,according to fibrinogen(FIB),platelet(PLT),and D-dimer(D-D),any of the elevated individuals is hypercoagulant,divide the patients into the Normal group and the Hyper-coagulation group.Statistically analyze the data with SPSS 19.0 to reveal the relevance to survival and coagulation indicators before and after the chemotherapy.Results:1 Relevance between the clinical factors and coagulation indicatorsClinical stages and PS score are positively correlated with the levels of FIB,PLT and D-D in two groups of non-small cell lung cancer patients.1.1 The FIB level of patients on stageⅣis 5.42±1.38g/L,PLT level352.50±49.71×10~9/L,D-D level 1.30±0.30mg/L,they’re significantly higher than them of whom on stageⅢb,which are FIB level 5.01±1.20g/L,PLT level289.40±55.60×10~9/L,D-D level 1.29±0.22mg/L,and the difference between them is statistical significant(P<0.05).1.2 The FIB level of the patients whose PS score is 1 is 5.52±1.40g/L,PLT level 308.32±50.10×10~9/L,D-D level 1.37±0.18mg/L,they’re significantly higher than them of whose PS score is 0,which are FIB level 5.15±1.62g/L,PLT level 259.43±46.40×10~9/L,D-D level 1.15±0.27mg/L,and the difference between them is statistical significant(P<0.05).1.3 Age,gender,pathological type are not relevant with the coagulation indies,the differences are not statistical significant(P>0.05).2 The changes of FIB,PLT,and D-D before and after chemotherapy2.1 Comparison and analysis to FIB before and after chemotherapyCompare the levels of FIB between two groups before and after chemotherapy.The FIB level of the Hyper-coagulation group before chemotherapy is close to two times higher than that of the Normal group(the Hyper-coagulation group 6.01±1.08g/L,the Normal group 3.1±0.91g/L).The FIB levels of two groups are statistically significant before and after chemotherapy(before and after chemotherapy:P<0.01).After chemotherapy,both groups’FIB level decrease,while the Hyper-coagulation group decreases slightly,but still higher than the upper limitof the normal range(the Hyper-coagulation group 4.89±0.77g/L,the Normal group 2.67±0.84g/L).Indicating that after chemotherapy,the FIB level of the Hyper-coagulation group decreases,but not returns to normal range yet.2.2 Comparison and analysis to PLT before and after chemotherapyStatistically analyse the PLT levels before and after chemotherapy between the Normal group and the Hyper-coagulation group,according to the results that can be seen,after chemotherapy,the PLT level of hyper-coagula-tion group decreases to normal range,but is still higher(before chemotherapy341.59±89.71×10~9/L,after chemotherapy 296.72±75.83×10~9/L).There are significant differences between the Hyper-coagulation group and the Normal group,both when before and after chemotherapy,the difference is statistically significant between the two groups before chemotherapy(before chemo-therapy:P<0.01,after chemotherapy:P<0.05).The results showes that the PLT level of NSCLC patients decreases after chemotherapy.2.3 Comparison and analysis to D-D before and after chemotherapyThe D-D levels of the Normal group and the Hyper-coagulation group both decrease after chemotherapy,and the level of Hyper-coagulation group decreasessignificantly.(theNormalgroupbeforechemotherapy:0.76±0.21mg/L,after chemotherapy 0.53±0.15mg/L;the Hyper-coagulation group before chemot-herapy:1.86±0.42mg/L,after chemotherapy0.64±0.34mg/L)There is statistic-ally significant difference in the D-D level between the high coagulation group and the Normal group before chemothe-rapy,and no significant difference between the two groups after chemotherapy(before chemotherapy:P<0.01,after chemotherapy:P>0.05).The results showes that after chemotherapy,the D-D levels of both two groups decrease,and the overall level of Hyper-coagulation group is similar to that of the Normal group.3 Relevance of FIB,PLT,D-D,with NSCLC survivalFollow up these 618 cases and analyse their censored values,the overall survival(OS)median is 15.6 months,the OS median of the Normal group is20.1 months and the Hyper-coagulation group 13.4 months,thus there is significantly statistical discrepancy(P<0.01).The one-year survival rate in the Hyper-coagulation group is 51.9%,the two-year survival rate is 11.6%,the three-year survival rate is 0%.The one-year survival rate in the Normal group is 89.7%,the two-year survival rate is 27.3%,the three-year survival rate is4.2%,the four-year survival rate is 0.2%,and the differences between them are statistical significant(P<0.01).4 Relevance between the clinical factors and survival4.1 Analyze the factors single by single may influence the prognosis such as age,gender,pathological type,PS value,clinical stage,FIB,PLT,D-D.The results show:the clinical stage(HR=1.33,95%CI:0.92-1.78,P<0.05),PS value(HR=1.83,95%CI:0.31-2.60,P<0.05),FIB(HR=1.62,95%CI:1.12-2.53,P<0.05),PLT(HR=1.26,95%CI:0.78-1.57,P<0.05),D-D(HR=1.13,95%CI:0.80-1.63,P<0.05)are factors can influence NSCLC prognosis.4.2 Analyze the factors(pathological type,TNM stage,PS value,FIB,PLT,D-D)which P<0.2 in single-factor analysis with COX test,results that clinical stage,FIB,D-D are independent factors(clinical stage:HR=1.207,P=0.029;FIB:HR=3.634,P=0.001;D-D:HR=1.664,P=0.008).Conclusions:1 All of the FIB、PLT、D-D levels of NSCLC patients change during chemotherapy,the differences between FIB and PLT before and after chemotherapy are statistical significant.2 Clinical stage,FIB,D-D are independent factors can influence prognosis.The survival of those patients whose FIB、PLT、D-D levels rise abnormally is lower than the normal,their prognoses are worse than the Normal group. |
