| Objective:The purpose of this study was to evaluate the diagnostic value of serum tumor markers(TMs),to compare the coagulation parameters in patients with benign or malignant pulmonary nodules,among different pathologic types of lung cancer,and among nodules of different diameter and size,by retrospective analysis of the serum tumor markers and coagulation parameters[prothrombin time(PT),activated partial thromboplastin time(APTT),International Normalized Ratio(INR),fibrinogen(FIB),D-Dimer,platelet(PLT)]in patients with pulmonary nodules before treatment.Methods:The clinical data(sex,age,tumor markers,coagulation indicators,blood routine examination and imaging data,pathological results)of the patients were involved in this retrospective analysis from June 2017 to June 2019.All patients came from thoracic surgery of the First Affiliated Hospital of Kunming Medical University.Pulmonary nodules are defined as focal,rounded,dense-increasing,solid or subsolid lung shadows with the diameter ?3 cm.They may be solitary or multiple,without atelectasis,hilar lymphadenopathy,or pleural effusion.All patients were diagnosed by pathology.Pathological diagnosis methods include electronic bronchoscopy biopsy,percutaneous lung biopsy,lobectomy or lung wedge resection.Results:A total of 609 patients were included in this study,which including 374 patients with lung cancer(190 males and 184 females),age(55.99± 10.27 years),311 patients with adenocarcinoma,37 patients with squamous cell carcinoma,26 patients with other types of malignant tumors,and 235 patients with benign lesions(117 males and 118 females),age(48.63± 11.94 years)The levels of CEA,AFP,CA125,CA153,NSE,CY21-1 and CA199 were statistically significant differences between patients with lung cancer and benign lung disease group(27.23±124.79ng/ml vs 2.42 ± 1.81ng/ml,P value=0.004,3.28±1.75ng/ml vs 2.82±1.25 ng/ml,P value=0.005,29.52±73.61U/ml vs 17.24±20.70U/ml,P value=0.025,15.44±19.57U/ml vs 12.16±6.52U/ml,P value=0.027,13.00±5.45ng/ml vs 11.83±3.47ng/ml,P value=0.017,4.21±4.59ng/ml vs 2.55±1.25 ng/ml,P value=0.000,18.40±28.47U/ml vs 11.32±8.59U/ml,P value=0.001).The levels of CEA,AFP,CA125,CA153,NSE,CY21-1 and CA199 was no statistically significant differences between adenocarcinoma patients and squamous cell carcinoma patients(31.52±135.53ng/ml vs 5.51±9.15ng/ml,P value=0.4341,3.31±1.79ng/ml vs 2.89±1.08ng/ml,P value=0.347,27.66±74.77U/ml vs 39.97±66.63U/ml,P value=0.526,15.88±21.03U/ml vs 12.08±6.58U/ml,P value=0.474,12.86±4.96ng/ml vs 12.69±8.26ng/ml,P value=0.904,3.69±2.66ng/ml vs 6.94±7.33ng/ml,P value=0.109,17.69 ± 27.51 U/ml vs 22.5 8±42.34U/ml,P value=0.529).The levels of APTT,PT,INR,FIB and PLT were no statistically significant differences between patients with malignant group and benign group(39.38±5.99s vs 39.69±5.88s,P value=0.607,13.09±1.42s vs 12.98±0.75s,P value=0.283,1.01±0.15 vs 1.00±0.12,P value=0.690,3.26±1.06g/L vs 3.20±1.48g/L,P value=0.584,245.18×10^9/L±72.94×10^9/L vs 241.31 ×10^9/L±69.16×10^9/L,P value=0.522).The levels of D-Dimer was statistically significant differences between patients with lung cancer and benign lung disease group(1.01±2.12ug/ml vs 0.40±0.36ug/ml,P value=0.002).Therefore,lung cancer patients showed abnormal coagulation function and hyperfibrinolysis.The levels of APTT,PT,INR,PLT and D-Dimer were no statistically significant differences between adenocarcinoma and squamous cell carcinoma(39.40±6.11s vs 40.89±5.68s,P value=0.152,13.07±1.51s vs 13.34±0.82s,P value=0.300,1.01±0.16 vs 1.03±0.08,P value=0.341,245.31×10^9/L±70.57×10^9/L vs 256.03×10^9/L±88.41 ×10^9/L,P value=0.409,0.94±2.20ug/ml vs 1.37±1.75ug/ml,P value=0.458).The levels of FIB was statistically significant differences between adenocarcinoma patients with squamous cell carcinoma(3.09±0.79g/L vs 4.26± 1.89g/L,P value=0.001),FIB in the squamous cell carcinoma Group was significantly higher than that in the adenocarcinoma group.All patients with pulmonary nodules were divided into the nodule group(1 cm<Diameter ?3 cm)and the small nodule group(Diameter ?1 cm)according to the diameter of the nodules.A total of 446 patients were divided into the nodule group,which including 293 patients with lung cancer(151 males and 142 females),age(57.06±9.82 years),242 patients with adenocarcinoma,32 patients with squamous cell carcinoma,19 patients with other types of malignant tumors,and 153 patients with benign lesions(81 males and 72 females),age(48.15± 12.46 years).A total of 163 patients were divided into the small nodule group,which including 81 patients with lung cancer(39 males and 42 females),age(52.10±10.98 years),69 patients with adenocarcinoma,5 patients with squamous cell carcinoma,7 patients with other types of malignant tumors,and 82 patients with benign lesions(36 males and 46 females),age(49.51±10.92 years).The coagulation parameters between benign and malignant nodules were compared in each group.In the nodule group,the levels of APTT,PT,INR,FIB and PLT were no statistically significant differences between patients with lung cancer and benign lung disease group(39.25±6.16s vs 39.85±6.14s,P value=0.343,13.12± 1.55s vs 13.00±0.76s,P value=0.367,1.01±0.17 vs 1.00 ±0.63,P value=0.339,3.28±1.04g/L vs 3.14±0.95g/L,P value=0.168,2 45.70×10^9/L±74.23×10^9/L vs 244.62×10^9/L±70.12×10^9/L,P value=0.884).The levels of D-Dimer was statistically significant differences between patients with lung cancer and benign lung disease group(1.10±2.29ug/ml vs 0.41 ±0.41ug/ml,P value=0.004).In the small nodule group,the levels of APTT,PT,INR,FIB,PLT and D-Dimer were no statistically significant differences between patients with lung cancer and benign lung disease group(39.89±5.29s vs 39.40±5.36s,P value=0.570,12.96±0.77s vs 2.94±0.73s,P value=0.834,0.99±0.84 vs 1.01±0.17,P value=0.360,3.17±1.14g/L vs 3.32±2.16g/L,P value=0.609,243.35×10^9/L±68.60×10^9/L vs 235.10×10^9/L±67.14×10^9/L,P value=0.272,0.61±0.99ug/ml vs 0.38±0.25ug/ml.P value=0.444).Conclusions:1.Serum CEA,AFP,CA125,CA153,CA199,CY21-1 and NSE are of significance in the diagnosis of lung malignant nodules.2.In patients with malignant pulmonary nodules less than 3cm in diameter,hypercoagulability and/or hyperfibrinolysis were observed in different degrees.3.In patients with malignant pulmonary nodules,coagulation indicators in perpheral blood are different according to different pathological types,and squamous cell carcinoma has more influence on FIB than adenocarcinoma.4.The level of D-Dimer of malignant nodules in small nodule group had less effect than that of the malignant nodules in nodule group.The larger the diameter of malignant nodules,the more likely it was to affect the coagulation function of patients.When the diameter of the nodule are less than or equal to 1 cm,anticoagulation therapy is not needed.When the diameter of the nodule are greater than 1 cm,anticoagulation therapy is feasible. |
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