Zhang Li-Peng, Ren Hu, Du Yong-Xing, Zheng Xiao-Hao, Zhang Zong-Ming, Wang Cheng-Feng
Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China.
World J Gastrointest Surg. 2021 Mar 27;13(3):279-302. doi: 10.4240/wjgs.v13.i3.279.
Patients with malignant tumors frequently exhibit hyperactivation of the coagulation system and secondary increased fibrinolytic activity. Fibrinogen and D-dimer are common indicators that are crucial in the coagulation/fibrinolysis system. Both indicators have been verified to have predictive value in the overall survival (OS) of many patients with solid malignancies.
To explore the prognostic significance of fibrinogen combined with D-dimer in pancreatic ductal adenocarcinoma (PDAC) patients undergoing radical R0 resection.
We retrospectively analyzed the clinical data of 282 patients with PDAC undergoing radical R0 resection in the Cancer Hospital, Chinese Academy of Medical Sciences, between January 2010 and December 2019. The surv_cutpoint function of R language was used to determine the optimal cutoff values of the preoperative fibrinogen concentration and preoperative D-dimer concentration. Enrolled patients were further divided into the any-high group (high preoperative fibrinogen concentration and/or high preoperative D-dimer concentration) and the low-low group (low preoperative fibrinogen and D-dimer concentrations) according to the optimal cutoff values.
The optimal cutoff values of the preoperative fibrinogen concentration and preoperative D-dimer concentration were 3.31 g/L and 0.53 mg/L, respectively. Furthermore, multivariate Cox regression analysis showed that the preoperative fibrinogen concentration (HR: 1.603, 95%CI: 1.201-2.140, 0.001) and preoperative D-dimer concentration (HR: 1.355, 95%CI: 1.019-1.801, 0.036) exhibited obvious correlations with the OS of PDAC patients undergoing radical R0 resection. A prognostic analysis was further performed based on the subgroup results by using fibrinogen combined with D-dimer. The median OS duration of the low-low group (31.17 mo) was significantly longer than that of the any-high group (15.43 mo). Additionally, multivariate Cox regression analysis revealed that the degree of differentiation ( 0.001), lymph node metastasis (HR: 0.663, 95%CI: 0.497-0.883, 0.005), preoperative CA19-9 level (HR: 1.699, 95%CI: 1.258-2.293, 0.001), adjuvant therapy (HR: 1.582, 95%CI: 1.202-2.081, 0.001) and preoperative combined grouping (HR: 2.397, 95%CI: 1.723-3.335, 0.001) were independent predictors of OS in PDAC patients undergoing radical R0 resection.
Preoperative fibrinogen combined with D-dimer plays a predictive role in OS, and low preoperative fibrinogen and D-dimer concentrations can indicate prolonged OS in PDAC patients undergoing radical R0 resection.
恶性肿瘤患者常表现出凝血系统的过度激活及继发性纤溶活性增加。纤维蛋白原和D-二聚体是凝血/纤溶系统中的常见关键指标。这两个指标均已被证实对许多实体恶性肿瘤患者的总生存期（OS）具有预测价值。
探讨纤维蛋白原联合D-二聚体对接受根治性R0切除的胰腺导管腺癌（PDAC）患者的预后意义。
我们回顾性分析了2010年1月至2019年12月在中国医学科学院肿瘤医院接受根治性R0切除的282例PDAC患者的临床资料。使用R语言的surv_cutpoint函数确定术前纤维蛋白原浓度和术前D-二聚体浓度的最佳截断值。根据最佳截断值，将纳入的患者进一步分为任意高值组（术前纤维蛋白原浓度高和/或术前D-二聚体浓度高）和低值组（术前纤维蛋白原和D-二聚体浓度低）。
术前纤维蛋白原浓度和术前D-二聚体浓度的最佳截断值分别为3.31 g/L和0.53 mg/L。此外，多因素Cox回归分析显示，术前纤维蛋白原浓度（HR：1.603，95%CI：1.201-2.140，P = 0.001）和术前D-二聚体浓度（HR：1.355，95%CI：1.019-1.801，P = 0.036）与接受根治性R0切除的PDAC患者的OS显著相关。基于纤维蛋白原联合D-二聚体的亚组结果进一步进行了预后分析。低值组的中位OS持续时间（31.17个月）显著长于任意高值组（15.43个月）。此外，多因素Cox回归分析显示，分化程度（P = 0.001）、淋巴结转移（HR：0.663，95%CI：0.497-0.883，P = 0.005）、术前CA19-9水平（HR：1.699，95%CI：1.258-2.293，P = 0.001）、辅助治疗（HR：1.582，95%CI：1.202-2.081，P = 0.001）和术前联合分组（HR：2.397，95%CI：1.723-3.335，P = 0.001）是接受根治性R0切除的PDAC患者OS的独立预测因素。
术前纤维蛋白原联合D-二聚体对OS具有预测作用，术前纤维蛋白原和D-二聚体浓度低可提示接受根治性R0切除的PDAC患者的OS延长。
