Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Thorac Cancer. 2020 Sep;11(9):2483-2492. doi: 10.1111/1759-7714.13559. Epub 2020 Jul 13.
Venous thromboembolism (VTE) occurs at a high rate after lung cancer surgery and can be attributed to various clinical risk factors. Here, we aimed to determine whether early detection of perioperative D-dimer and risk-stratified cutoff values would improve the diagnostic efficacy of VTE.
In this case-control study, D-dimer results were acquired from 171 non-small cell lung cancer (NSCLC) patients preoperatively and at the first, third, and fifth day after surgery. VTE was confirmed by Doppler ultrasonography and computer tomography pulmonary angiography (CTPA). Repeated measures ANOVA was used to analyze how D-dimer changed with time and the effects of risk factors on D-dimer levels. We then compared sensitivity, specificity and negative predictive value, using both adjusted and unadjusted cutoff values.
VTE occurred in 23 patients (13.5%) of the study population. D-dimer levels increased unsustainably after lung cancer surgery (P < 0.001) due to a trough on the third day, and patients who had undergone thoracotomy (P < 0.001) and those at a more advanced tumor stage (P = 0.037) had higher D-dimer levels. Area under the curve of D-dimer was greatest on the third day (0.762 [P < 0.001, 95% CI: 0.643-0.882]). Applying stratified cutoff values improved the specificity in the video-assisted thoracoscopy surgery (VATS) (P = 0.004) and thoracotomy groups (P < 0.001).
D-dimer levels elevated with fluctuation in NSCLC patients after surgery. Surgical options and tumor stages had an impact on D-dimer levels. With regard to VTE diagnosis, stratified cutoff values by these two factors showed better accuracy compared with a collective one..
SIGNIFICANT FINDINGS OF THE STUDY: The changing pattern of perioperative D-dimer levels in NSCLC patients who received surgical therapy in a major teaching hospital in Beijing, China was revealed.
Risk-stratified D-dimer cutoff values adjusted to surgical methods and disease stages would benefit the exclusion of postoperative venous thromboembolism.
肺癌手术后静脉血栓栓塞症（VTE）的发生率很高，可归因于各种临床危险因素。在这里，我们旨在确定围手术期 D-二聚体的早期检测和风险分层截止值是否会提高 VTE 的诊断效果。
在这项病例对照研究中，我们从 171 例非小细胞肺癌（NSCLC）患者术前以及术后第 1、3 和 5 天获得了 D-二聚体的结果。通过多普勒超声和计算机断层肺动脉造影（CTPA）确认 VTE。重复测量方差分析用于分析 D-二聚体如何随时间变化以及危险因素对 D-二聚体水平的影响。然后，我们比较了使用调整和未调整的截止值的灵敏度、特异性和阴性预测值。
在研究人群中，23 例（13.5%）发生 VTE。由于第 3 天出现低谷，肺癌手术后 D-二聚体水平持续升高（P < 0.001），并且接受了剖胸手术（P < 0.001）和肿瘤分期更晚的患者（P = 0.037）的 D-二聚体水平更高。D-二聚体的曲线下面积在第 3 天最大（0.762[P < 0.001，95%CI：0.643-0.882]）。分层截止值的应用提高了电视辅助胸腔镜手术（VATS）（P = 0.004）和剖胸手术组（P < 0.001）的特异性。
手术后非小细胞肺癌患者的 D-二聚体水平升高且波动。手术方案和肿瘤分期对 D-二聚体水平有影响。就 VTE 诊断而言，这两个因素的分层截止值与集体截止值相比具有更高的准确性。
本研究的重要发现：揭示了中国北京一家教学医院接受手术治疗的 NSCLC 患者围手术期 D-二聚体水平的变化模式。
针对手术方法和疾病阶段调整的分层 D-二聚体截止值将有助于排除术后静脉血栓栓塞症。
