Department of Urology, Peking University Third Hospital, Beijing, China.
Chin Med J (Engl). 2011 Apr;124(8):1205-8.
The coagulation function in carcinoma patients is abnormal, but in renal cell carcinoma the extent and relationships of coagulation function remain unclear. This study retrospectively investigated the relationships between coagulation function, clinical stage and metastasis in patients with renal cell carcinoma.
A total of 350 consecutive patients admitted to our Urology Department from 2004 to 2010 were diagnosed with renal cell carcinoma by histopathologic examination and were included in this study. A total of 231 cases of renal benign tumors were considered as the control group. Fibrinogen, prothrombin time, activated partial thromboplastin time and international normalized ratio were evaluated in all subjects. Tumor size, clinical stage, lymph node metastasis, and distant metastasis were evaluated using radiologic imaging, intraoperative findings, and histological studies.
The preoperative plasma fibrinogen levels of patients with renal cell carcinoma ((383.9 ± 146.7) mg/dl) were significantly higher than those of the control group ((316.7 ± 62.0) mg/dl) (P < 0.01). We divided the renal cell carcinoma group into stages Ia, Ib, II, III, and IV. The fibrinogen values were (315.6 ± 64.6) mg/dl, (358.3 ± 91.1) mg/dl, (465.6 ± 164.7) mg/dl, (500.0 ± 202.1) mg/dl, and (585.8 ± 179.7) mg/dl, respectively. There were no significant differences in fibrinogen values between stage Ia and control groups. However, results of other stages showed significant differences when compared to control group values (P < 0.01). Using the cutoff value of 440 mg/dl, which defines hyperfibrinogenemia, plasma fibrinogen levels had a positive predictive value of 39.8% and a negative predictive value of 93.3% for predicting distant metastasis, with a sensitivity of 64.7% and specificity of 83.3%.
Preoperative plasma fibrinogen levels are elevated in patients with renal cell carcinoma with distant metastasis or lymph node metastasis. Potential metastasis is more likely if the tumor size larger than 4 cm. Increased preoperative plasma fibrinogen levels, especially hyperfibrinogenemia, may be an indicator of metastasis.
癌症患者的凝血功能异常，但在肾细胞癌中，凝血功能的程度和关系尚不清楚。本研究回顾性调查了凝血功能与肾细胞癌患者的临床分期和转移之间的关系。
本研究共纳入 2004 年至 2010 年间在我院泌尿外科接受治疗的 350 例经组织病理学检查诊断为肾细胞癌的连续患者，并将其纳入本研究。将 231 例肾良性肿瘤患者作为对照组。所有患者均评估纤维蛋白原、凝血酶原时间、活化部分凝血活酶时间和国际标准化比值。使用影像学、术中发现和组织学研究评估肿瘤大小、临床分期、淋巴结转移和远处转移。
肾细胞癌患者术前血浆纤维蛋白原水平[（383.9 ± 146.7）mg/dl]明显高于对照组[（316.7 ± 62.0）mg/dl]（P < 0.01）。我们将肾细胞癌组分为 Ia、Ib、II、III 和 IV 期。纤维蛋白原值分别为（315.6 ± 64.6）mg/dl、（358.3 ± 91.1）mg/dl、（465.6 ± 164.7）mg/dl、（500.0 ± 202.1）mg/dl 和（585.8 ± 179.7）mg/dl。Ia 期与对照组纤维蛋白原值无显著差异，但其他各期与对照组比较差异均有统计学意义（P < 0.01）。使用定义为高纤维蛋白原血症的 440 mg/dl 截断值，血浆纤维蛋白原水平对预测远处转移的阳性预测值为 39.8%，阴性预测值为 93.3%，灵敏度为 64.7%，特异性为 83.3%。
远处转移或淋巴结转移的肾细胞癌患者术前血浆纤维蛋白原水平升高。肿瘤直径大于 4 cm 时，更有可能发生转移。术前血浆纤维蛋白原水平升高，尤其是高纤维蛋白原血症，可能是转移的指标。
