Ay Cihan, Vormittag Rainer, Dunkler Daniela, Simanek Ralph, Chiriac Alexandru-Laurentiu, Drach Johannes, Quehenberger Peter, Wagner Oswald, Zielinski Christoph, Pabinger Ingrid
Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Waehringer GuerA-1090 Vienna, Austria.
J Clin Oncol. 2009 Sep 1;27(25):4124-9. doi: 10.1200/JCO.2008.21.7752. Epub 2009 Jul 27.
Venous thromboembolism (VTE) is a well-recognized complication of cancer. Laboratory parameters might be useful to assess the VTE risk in patients with cancer. The aim of this study was to investigate D-dimer and prothrombin fragment 1 + 2 (F 1 + 2), which reflect activation of blood coagulation and fibrinolysis, for prediction of cancer-associated VTE.
In a prospective, observational, cohort study of 821 patients with newly diagnosed cancer or progression of disease who did not recently receive chemotherapy, radiotherapy, or surgery were enrolled and followed for a median of 501 days (interquartile range, 255 to 731 days). The malignancies in these patients were as follows: breast (n = 132), lung (n = 119), stomach (n = 35), lower gastrointestinal tract (n = 106), pancreas (n = 46), kidney (n = 22), and prostate (n = 101) cancers; high-grade glioma (n = 102); malignant lymphoma (n = 94); multiple myeloma (n = 17); and other tumor types (n = 47). The study end point was occurrence of objectively confirmed symptomatic or fatal VTE.
VTE occurred in 62 patients (7.6%). The cutoff level for elevated D-dimer and elevated F 1 + 2 was set at the 75th percentile of the total study population. In multivariable analysis that included elevated D-dimer, elevated F 1 + 2, age, sex, surgery, chemotherapy, and radiotherapy, the hazard ratios (HRs) of VTE in patients with elevated D-dimer (HR, 1.8; 95% CI, 1.0 to 3.2; P = .048) and elevated F 1 + 2 (HR, 2.0; 95% CI, 1.2 to 3.6; P = .015) were statistically significantly increased. The cumulative probability of developing VTE after 6 months was highest in patients with both elevated D-dimer and elevated F 1 + 2 (15.2%) compared with patients with nonelevated D-dimer and nonelevated F 1 + 2 (5.0%; P < .001).
High D-dimer and F 1 + 2 levels independently predict occurrence of VTE in patients with cancer.
静脉血栓栓塞症（VTE）是一种公认的癌症并发症。实验室指标可能有助于评估癌症患者的VTE风险。本研究旨在探讨反映凝血和纤溶激活的D - 二聚体和凝血酶原片段1 + 2（F 1 + 2）对预测癌症相关VTE的价值。
在一项前瞻性、观察性队列研究中，纳入821例新诊断癌症或疾病进展且近期未接受化疗、放疗或手术的患者，中位随访501天（四分位间距，255至731天）。这些患者的恶性肿瘤类型如下：乳腺癌（n = 132）、肺癌（n = 119）、胃癌（n = 35）、下消化道癌（n = 106）、胰腺癌（n = 46）、肾癌（n = 22）、前列腺癌（n = 101）；高级别胶质瘤（n = 102）；恶性淋巴瘤（n = 94）；多发性骨髓瘤（n = 17）；以及其他肿瘤类型（n = 47）。研究终点为客观证实的有症状或致命性VTE的发生。
62例患者（7.6%）发生VTE。将D - 二聚体升高和F 1 + 2升高的临界值设定为整个研究人群的第75百分位数。在包括D - 二聚体升高、F 1 + 2升高、年龄、性别、手术、化疗和放疗的多变量分析中，D - 二聚体升高患者发生VTE的风险比（HR，1.8；95% CI，1.0至3.2；P = .048）和F 1 + 2升高患者发生VTE的风险比（HR，2.0；95% CI，1.2至3.6；P = .015）在统计学上显著升高。与D - 二聚体和F 1 + 2均未升高的患者（5.0%；P < .001）相比，D - 二聚体和F 上均升高的患者6个月后发生VTE的累积概率最高（15.2%）。
高D - 二聚体和F 1 + 上水平可独立预测癌症患者VTE的发生。
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