Guo Renyong, Yang Jiezuan, Liu Xia, Wu Jianping, Chen Yu
Department of Laboratory Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, Zhejiang, China.
J Clin Lab Anal. 2018 Jan;32(1). doi: 10.1002/jcla.22219. Epub 2017 Apr 4.
Hypercoagulability induced by the imbalance between von Willebrand factor (VWF) secretion and its cleaving protease (ADAMTS-13) has been correlated with cancer metastasis. The aim of this study was to explore the prognostic significance of the VWF/ADAMTS-13 ratio in advanced non-small-cell lung cancer (NSCLC).
Pre-treatment sera/plasma levels of VWF, ADAMTS-13, VWF/ADAMTS-13 ratio, factor (F) VIII, and other clinical/laboratory parameters were measured in 119 patients with advanced NSCLC and 102 healthy controls. All patients were followed up to determine the predictive value of these parameters for prognosis of advanced NSCLC.
Elevated VWF, VWF/ADAMTS-13 ratio, and reduced ADAMTS-13 were significantly correlated with the stage and grade of advanced NSCLC and the final status of disease (P<.05). VWF levels and the VWF/ADAMTS-13 ratio were also associated with response to chemotherapy (P<.05). Multivariate analysis identified the VWF/ADAMTS-13 ratio and D-dimer as significant independent predictors of patient mortality. The area under the curve showed that the VWF/ADAMTS-13 ratio was more useful than VWF, ADAMTS-13, and D-dimer to predict mortality. Kaplan-Meier analysis showed that a low VWF/ADAMTS-13 ratio was significantly predictive of improved survival (P=.004).
These results suggest that the imbalance between VWF secretion and ADAMTS-13 may play a critical role in the hypercoagulability state in advanced NSCLC. Moreover, elevation of the plasma VWF/ADAMTS-13 ratio may serve as an independent predictive factor for mortality in patients with advanced NSCLC.
血管性血友病因子（VWF）分泌与其裂解蛋白酶（ADAMTS-13）之间的失衡所诱导的高凝状态与癌症转移相关。本研究旨在探讨VWF/ADAMTS-13比值在晚期非小细胞肺癌（NSCLC）中的预后意义。
测定了119例晚期NSCLC患者和102例健康对照者治疗前血清/血浆中VWF、ADAMTS-13、VWF/ADAMTS-13比值、因子（F）VIII以及其他临床/实验室参数水平。对所有患者进行随访，以确定这些参数对晚期NSCLC预后的预测价值。
VWF升高、VWF/ADAMTS-13比值升高以及ADAMTS-13降低与晚期NSCLC的分期、分级及疾病最终状态显著相关（P<0.05）。VWF水平和VWF/ADAMTS-13比值也与化疗反应相关（P<0.05）。多因素分析确定VWF/ADAMTS-13比值和D-二聚体是患者死亡率的显著独立预测因素。曲线下面积显示，VWF/ADAMTS-13比值在预测死亡率方面比VWF、ADAMTS-13和D-二聚体更有用。Kaplan-Meier分析显示，低VWF/ADAMTS-13比值显著预测生存期改善（P=0.004）。
这些结果表明，VWF分泌与ADAMTS-13之间的失衡可能在晚期NSCLC的高凝状态中起关键作用。此外，血浆VWF/ADAMTS-13比值升高可能作为晚期NSCLC患者死亡率的独立预测因素。
