治疗前血浆D-二聚体在实体瘤患者中的预后作用：一项系统评价和Meta分析
Prognostic Role of Pretreatment Plasma D-Dimer in Patients with Solid Tumors: a Systematic Review and Meta-Analysis.
作者信息
Li Wenhan, Tang Yao, Song Yongchun, Chen Szu Hao, Sisliyan Navard, Ni Ming, Zhang Hao, Zeng Qingnuo, Hou Bin, Xie Xin, Chang Dongmin
机构信息
Department of Surgical Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of general surgery, Xi'an No.3 hospital, Xi'an, China.
出版信息
Cell Physiol Biochem. 2018;45(4):1663-1676. doi: 10.1159/000487734. Epub 2018 Feb 22.
BACKGROUND/AIMS: Elevated pretreatment plasma D-dimer level has been reported as an unfavorable prognostic indicator in several malignancies. The aim of this meta-analysis was to evaluate the prognostic value of elevated D-dimer level in solid tumors.
METHODS
A comprehensive search of electronic databases up to June 10, 2017 was carried out by two independent reviewers. We included studies exploring the association between pretreatment plasma D-dimer level and patients' survival outcomes in solid tumors. Overall survival (OS) was regarded as primary outcome and progression-free survival (PFS), disease-free survival (DFS) as well as cancer-specific survival (CSS) were chosen as secondary outcomes. Hazard ratio and 95% confidence interval (CI) were extracted directly or indirectly from included studies.
RESULTS
49 studies with 13001 patients were included in our meta-analysis. Elevated D-dimer was markedly associated with poor OS (pooled HR = 1.90, 95% CI = 1.63 - 2.20, P < 0.001). The effect was observed in all different tumor sites, disease stages, cut-off values and ethnicities. Meanwhile, patients with a high plasma D-dimer had a shorter PFS (HR = 1.46, 95% CI = 1.22-1.76; P < 0.001), DFS (HR = 2.02, 95% CI = 1.56-2.62) and CSS (HR = 2.04, 95% CI= 1.58 - 2.64).
CONCLUSIONS
Analysis of the pretreatment plasma D-dimer might provide useful information to predict prognosis in patients with solid tumors.
背景/目的：已有报道称，在多种恶性肿瘤中，治疗前血浆D-二聚体水平升高是一个不良预后指标。本荟萃分析的目的是评估D-二聚体水平升高在实体瘤中的预后价值。
方法
两名独立的研究者对截至2017年6月10日的电子数据库进行了全面检索。我们纳入了探索实体瘤治疗前血浆D-二聚体水平与患者生存结局之间关联的研究。总生存期（OS）被视为主要结局，无进展生存期（PFS）、无病生存期（DFS）以及癌症特异性生存期（CSS）被选为次要结局。风险比和95%置信区间（CI）直接或间接从纳入的研究中提取。
结果
我们的荟萃分析纳入了49项研究，共13001例患者。D-二聚体水平升高与较差的总生存期显著相关（合并风险比=1.90，95%CI=1.63-2.20，P<0.001）。在所有不同的肿瘤部位、疾病分期、临界值和种族中均观察到了这种效应。同时，血浆D-二聚体水平高的患者的无进展生存期（风险比=1.46，95%CI=1.22-1.76；P<0.001）、无病生存期（风险比=2.02，95%CI=1.56-2.62）和癌症特异性生存期（风险比=2.04，95%CI=1.58-2.64）较短。
结论
对治疗前血浆D-二聚体的分析可能为预测实体瘤患者的预后提供有用信息。
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