Wang Zhe, Fu Junke, Diao Dongmei, Dang Chengxue
Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
Zhongguo Fei Ai Za Zhi. 2011 Jun;14(6):534-7. doi: 10.3779/j.issn.1009-3419.2011.06.10.
Some operable non-small cell lung cancer (NSCLC) patients have poor prognosis shortly after the surgery. D-dimer (DD) is an independent prognosis factor of lung cancer, especially for inoperable patients. The aim of the study is to investigate whether the pre-operative plasma DD level could predict the poor prognosis shortly after the surgery in operable NSCLC patients.
The pre-operative plasma DD level of 56 newly diagnosed NSCLC patients without metastasis was examined. All the patients had been followed for one year post-operatively and the end-point was the occurrence of the poor prognosis incident including any sign of the metastasis, local recurrence or death related with the lung cancer. Difference of prognosis according to pre-operative plasma DD level was compared by Chi-square test. Diseases progress was analyzed by Kaplan-Meier method.
Among 56 NSCLC patients, 91% had received the curative resections (44 lobectomy and 7 pneumonectomy). There were still 2 cases of the wedge resection and 3 cases of the exploration. The median of the pre-operative plasma DD level was 1.05 (0.55) mg/L. The patients were allocated into two subgroups by the median of the DD levels. There were 11 patients with poor prognosis within one year after the resection in the high DD subgroup, while 3 patients in the low DD subgroup (P=0.03, OR=4.89, 95%CI: 1.2-20.1). The diseases progress curves were significantly different between the high and low subgroups (P=0.024). Based on plasma DD level, the poor prognosis incident within one year after the surgery was best predicted in the early stage (I, II) of the NSCLC, especially in adenocarcinoma patients.
The pre-operative plasma DD levels may predict the poor prognosis within one year after the surgery in NSCLC. The measurement of the fibrinolysis marker may help to exclude the unfit patients for the surgery.
部分可手术切除的非小细胞肺癌（NSCLC）患者术后预后较差。D-二聚体（DD）是肺癌的独立预后因素，尤其对于不可手术切除的患者。本研究旨在探讨术前血浆DD水平能否预测可手术切除的NSCLC患者术后短期内的不良预后。
检测56例新诊断的无转移NSCLC患者的术前血浆DD水平。所有患者术后随访1年，终点为不良预后事件的发生，包括任何转移迹象、局部复发或与肺癌相关的死亡。采用卡方检验比较术前血浆DD水平不同时的预后差异。用Kaplan-Meier法分析疾病进展情况。
56例NSCLC患者中，91%接受了根治性切除术（44例肺叶切除术和7例全肺切除术）。仍有2例行楔形切除术，3例行探查术。术前血浆DD水平的中位数为1.05（0.55）mg/L。根据DD水平的中位数将患者分为两个亚组。高DD亚组中有11例患者在切除术后1年内预后不良，而低DD亚组中有3例（P=0.03，OR=4.89，95%CI：1.2-20.1）。高、低亚组之间的疾病进展曲线有显著差异（P=0.024）。基于血浆DD水平，术后1年内的不良预后事件在NSCLC早期（I、II期），尤其是腺癌患者中预测效果最佳。
术前血浆DD水平可能预测NSCLC患者术后1年内的不良预后。纤溶标志物的检测可能有助于排除不适合手术的患者。
