胃癌患者多种凝血相关因子与淋巴结转移的相关性：一项回顾性队列研究。
Association between multiple coagulation-related factors and lymph node metastasis in patients with gastric cancer: A retrospective cohort study.
作者信息
Qiao Wenhao, Sha Shengxu, Song Jiyuan, Chen Yuezhi, Lian Guodong, Wang Junke, Zhou Xinxiu, Peng Lipan, Li Leping, Tian Feng, Jing Changqing
机构信息
Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China.
Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
出版信息
Front Oncol. 2023 Feb 23;13:1099857. doi: 10.3389/fonc.2023.1099857. eCollection 2023.
BACKGROUND
Patients with tumors generally present with accompanying activation of the coagulation system, which may be related to tumor stage. To our knowledge, few studies have examined the activation of the coagulation system in reference to lymph node metastasis within gastric cancer. This study aimed to investigate the correlation between multiple coagulation-related factors and lymph node metastasis in patients with gastric cancer after excluding the influence of tumor T stage.
MATERIALS AND METHODS
We retrospectively evaluated the relationship between lymph node metastasis and coagulation-related factors in 516 patients with T4a stage gastric cancer. We further analyzed influencing factors for lymph node metastasis and verified the predictive value of maximum amplitude (MA, a parameter of thromboelastography which is widely used to assess the strength of platelet-fibrinogen interaction in forming clots) in reference to lymph node metastasis.
RESULTS
Platelet counts (P=0.011), fibrinogen levels (P=0.002) and MA values (P=0.006) were statistically significantly higher in patients with T4a stage gastric cancer presenting with lymph node metastasis than in those without lymph node metastasis. Moreover, tumor N stage was statistically significantly and positively correlated with platelet count (P<0.001), fibrinogen level (P=0.003), MA value (P<0.001), and D-dimer level (P=0.010). The MA value was an independent factor for lymph node metastasis (β=0.098, 95% CI: 1.020-1.193, P=0.014) and tumor N stage (β=0.059, 95% CI: 0.015-0.104, P=0.009), and could be used to predict the presence of lymph node metastasis in patients with gastric cancer (sensitivity 0.477, specificity 0.783, P=0.006). The independent influencing factors for MA value mainly included platelet levels, fibrinogen levels, D-dimer and hemoglobin levels; we found no statistically significant correlations with tumor diameter, tumor area, and other evaluated factors.
CONCLUSION
We conclude that MA value is an independent influencing factor for lymph node metastasis and tumor N stage in patients with T4a stage gastric cancer. The MA value has important value in predicting the presence or absence of lymph node metastasis in patients with gastric cancer.
CLINICAL TRIAL REGISTRATION
http://www.chictr.org.cn, identifier ChiCTR2200064936.
背景
肿瘤患者通常伴有凝血系统激活，这可能与肿瘤分期有关。据我们所知，很少有研究探讨胃癌中凝血系统激活与淋巴结转移的关系。本研究旨在排除肿瘤T分期的影响，探讨胃癌患者多种凝血相关因素与淋巴结转移之间的相关性。
材料与方法
我们回顾性评估了516例T4a期胃癌患者淋巴结转移与凝血相关因素之间的关系。我们进一步分析了淋巴结转移的影响因素，并验证了最大振幅（MA，血栓弹力图的一个参数，广泛用于评估血小板 - 纤维蛋白原相互作用形成凝块的强度）对淋巴结转移的预测价值。
结果
出现淋巴结转移的T4a期胃癌患者的血小板计数（P = 0.011）、纤维蛋白原水平（P = 0.002）和MA值（P = 0.006）在统计学上显著高于未出现淋巴结转移的患者。此外，肿瘤N分期与血小板计数（P < 0.001）、纤维蛋白原水平（P = 0.003）、MA值（P < 0.001）和D - 二聚体水平（P = 0.010）在统计学上显著正相关。MA值是淋巴结转移（β = 0.098，95% CI：1.020 - 1.193，P = 0.014）和肿瘤N分期（β = 0.059，95% CI：0.015 - 0.104，P = 0.009）的独立因素，可用于预测胃癌患者是否存在淋巴结转移（敏感性0.477，特异性0.783，P = 0.006）。MA值的独立影响因素主要包括血小板水平、纤维蛋白原水平、D - 二聚体和血红蛋白水平；我们发现与肿瘤直径、肿瘤面积及其他评估因素无统计学显著相关性。
结论
我们得出结论，MA值是T4a期胃癌患者淋巴结转移和肿瘤N分期的独立影响因素。MA值在预测胃癌患者淋巴结转移的有无方面具有重要价值。
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