Blackwell K, Haroon Z, Broadwater G, Berry D, Harris L, Iglehart J D, Dewhirst M, Greenberg C
Divisions of Medical and Radiation Oncology, Duke University Comprehensive Cancer Center, Durham, NC 27710, USA.
J Clin Oncol. 2000 Feb;18(3):600-8. doi: 10.1200/JCO.2000.18.3.600.
To investigate the relationship between preoperative plasma D-dimer levels and extent of tumor involvement in operable breast cancer patients.
A total of 140 preoperative plasma specimens were obtained from women scheduled to undergo diagnostic breast biopsies. Ninety-five patients in the initial group went on to undergo axillary lymph node dissection. Of the 140 patients from whom plasma samples were obtained, 102 were subsequently diagnosed with invasive breast carcinoma, nine were subsequently diagnosed with ductal carcinoma-in-situ, and 20 were subsequently diagnosed with benign breast disease. Plasma D-dimer levels were quantitated using a commercially available immunoassay kit (DIMERTEST; American Diagnostica, Greenwich, CT). The relationships between plasma D-dimer and other prognostic variables (tumor size, estrogen receptor, progesterone receptor, nuclear grade, histologic grade, lymphovascular invasion, and clinical stage grouping) were then examined using univariate and multivariate linear and logistic regression analyses.
Median plasma D-dimer levels were significantly higher in patients with invasive carcinoma than those patients with either benign breast disease or carcinoma-in-situ (P =.0001). A significant relationship existed between the presence of elevated D-dimer (> 100 ng/mL) and involved axillary lymph nodes (chi(2) test; P =.001). Elevated D-dimer levels predicted positive lymph node involvement in both univariate regression (P =.0035) and multivariate linear regression (P =.012) models. In addition, elevated D-dimer levels predicted the presence of lymphovascular invasion in univariate logistic regression (P =. 0025) and multivariate logistic regression analysis (P =.0053). Quantitative D-dimer levels were highly correlated with clinical stage grouping (analysis of variance test; P =.002).
Plasma D-dimer levels were markers of lymphovascular invasion, clinical stage, and lymph node involvement in operable breast cancer. This correlation suggests that detectable fibrin degradation, as measured by plasma D-dimer, is a clinically important marker for lymphovascular invasion and early tumor metastasis in operable breast cancer.
探讨可手术乳腺癌患者术前血浆D - 二聚体水平与肿瘤累及范围之间的关系。
共采集了140例计划接受乳腺诊断性活检女性的术前血浆样本。初始组中的95例患者随后接受了腋窝淋巴结清扫术。在采集血浆样本的140例患者中，102例随后被诊断为浸润性乳腺癌，9例随后被诊断为原位导管癌，20例随后被诊断为乳腺良性疾病。使用市售免疫分析试剂盒（DIMERTEST；美国诊断公司，格林威治，康涅狄格州）对血浆D - 二聚体水平进行定量。然后使用单变量和多变量线性及逻辑回归分析来检验血浆D - 二聚体与其他预后变量（肿瘤大小、雌激素受体、孕激素受体、核分级、组织学分级、淋巴管侵犯和临床分期分组）之间的关系。
浸润性癌患者的血浆D - 二聚体水平中位数显著高于乳腺良性疾病或原位癌患者（P = 0.0001）。D - 二聚体升高（> 100 ng/mL）与腋窝淋巴结受累之间存在显著关系（卡方检验；P = 0.001）。在单变量回归（P = 0.0035）和多变量线性回归（P = 0.012）模型中，D - 二聚体水平升高预示着淋巴结转移阳性。此外，在单变量逻辑回归（P = 0.0025）和多变量逻辑回归分析（P = 0.0053）中，D - 二聚体水平升高预示着存在淋巴管侵犯。定量D - 二聚体水平与临床分期分组高度相关（方差分析检验；P = 0.002）。
血浆D - 二聚体水平是可手术乳腺癌中淋巴管侵犯、临床分期和淋巴结受累的标志物。这种相关性表明，通过血浆D - 二聚体检测到的纤维蛋白降解是可手术乳腺癌中淋巴管侵犯和早期肿瘤转移的重要临床标志物。
