Concomitant Genetic Alterations Are Associated With Plasma D-dimer Levels In Patients With Non-small Cell Lung Cancer

Objective: Previous studies have reported that the level of D-dimer is related to the poor prognosis of patients with non-small cell lung cancer（NSCLC）,while the incidence of NSCLC is highly related to the mutation of multiple genes.This study aimed to analyze the effect of concomitant mutations on the prognosis of patients with NSCLC.It also provides a new idea for predicting the occurrence of concomitant mutations and the formulation of an individualized treatment plan for NSCLC patients.Methods: A total of 574 patients who were first diagnosed with lung cancer in the First Affiliated Hospital of Anhui Medical University from March 2016 to July 2020 were included in the study.The clinical baseline data of patients were collected,including age,gender,clinical stage,histological diagnosis,smoking history,gene mutation,other treatment methods,concomitant disease history,etc.In addition,the laboratory test results of the first test after admission,including blood routine（proportion of red blood cells,white blood cells,lymphocytes,monocytes,platelets,etc.）,liver and kidney function（albumin,bilirubin,alanine aminotransferase,aspartate aminotransferase,urea nitrogen,creatinine,uric acid,etc.）,bleeding and coagulation index（D-dimer concentration）and other indicators were included for evaluation.The mutations of ALK,BRAF,EGFR,HER2/ERBB2,KRAS,MET,PIK3 CA,RET and ROS1 were detected by Next-generation sequencing（NGS）.Appropriate statistical methods were used to analysis the mutation information,clinical baseline data,and laboratory test data.Results: All patients were divided into three groups: wild type group,single gene mutation group,and concomitant mutation group.The analysis of D-dimer,uric acid（UA）,gender,family history,smoking history,histology,and distant metastasis all showed significant differences in the three groups（P < 0.05）.According to the unordered multiple logistic regression analysis,D-dimer was considered a risk factor for concomitant mutations.The receiver operating characteristic（ROC）curve analysis indicated that D-dimer had a crucial predictive value for the occurrence of concurrent mutations（AUC = 0.94,Sensitivity=88.71%,Specificity=86.46%）.There was a significantly shorter median PFS in the concomitant mutation group than in the single mutation group（7.70 months vs.14.00 months,P=0.0133）.Conclusion: Concomitant mutations are not uncommon in non-small cell lung cancer（NSCLC）patients,and plasma D-dimer levels are higher in NSCLC patients with concomitant mutations than those with single-gene mutations.D-dimer had a significant correlation with concomitant mutations in NSCLC patients.NSCLC patients with concomitant mutations generally exhibited worse PFS.D-dimer may serve as a specific marker for predicting multiple gene co mutations and long-term prognosis in patients with NSCLC.