术前血浆 D-二聚体水平升高是可切除性胰腺癌患者的独立预后因素：一项回顾性分析。

Elevated preoperative plasma D-dimer level was an independent prognostic factor for patients with PDAC after curative resection: a retrospective analysis.

机构信息

Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Hexi District, Tianjin, China.

Department of Hepatobiliary-Pancreatic-Splenic Surgery, Inner Mongolia Autonomous Region People's Hospital, Hohhot, China.

出版信息

Jpn J Clin Oncol. 2023 Nov 5;53(11):1058-1067. doi: 10.1093/jjco/hyad090.

DOI:10.1093/jjco/hyad090

PMID:37539583

Abstract

OBJECTIVE

In this study, the relationship between preoperative plasma D-dimer level and overall survival and recurrence free survival were evaluated in patients with curative resection of pancreatic ductal adenocarcinoma.

METHODS

Preoperative plasma D-dimer level of 573 patients with pancreatic ductal adenocarcinoma were collected. The univariate and multivariate Cox hazard models were used to identify independent variables associated with overall survival and recurrence free survival in this study. The Kaplan-Meier method was used to evaluate overall survival and recurrence free survival, and the differences between survival curves were analyzed using the Log-rank test. Continuous variables were presented as $\overline{x}\pm s$, parametric analysis was performed using t-test. Categorical variables were analyzed by means of the chi-square or Fisher's exact test.

RESULTS

Based on the analysis for the whole study, the results showed that patients in the elevated plasma D-dimer levels had a tendency to have an elder mean age (58.69 ± 8.32 years vs. 63.05 ± 8.44 years, P < 0.001), larger tumour size ≥4 cm (P = 0.006), advanced T stage (P = 0.024), N stage (P = 0.041), Tumor, Node and Metastasis (TNM) stage (P = 0.029) and postoperative complications (P = 0.042) was more likely occurred. Besides, according to the results of Cox multivariate analysis, elevated preoperative plasma D-dimer level was an independent prognostic factor not only for overall survival (Hazard Ratio (HR):1.430, 95% Confidence Interval (CI) (1.163-1.759), P = 0.001) but also for recurrence free survival (HR:1.236, 95% CI (1.018-1.500), P = 0.032).

CONCLUSION

In our study, the elevated preoperative plasma D-dimer level may act as an independent prognostic factor for overall survival and recurrence free survival in patients with pancreatic ductal adenocarcinoma after curative resection. Pancreatic ductal adenocarcinoma patients with elevated preoperative plasma D-dimer level had a worse prognosis than those with normal plasma D-dimer level; and the elevated preoperative plasma D-dimer level may imply heavy tumour burden and provide supplementary information regarding disease status.

摘要

目的

本研究评估了术前血浆 D-二聚体水平与可切除性胰腺导管腺癌患者的总生存和无复发生存之间的关系。

方法

收集了 573 例胰腺导管腺癌患者的术前血浆 D-二聚体水平。本研究采用单因素和多因素 Cox 风险模型来确定与总生存和无复发生存相关的独立变量。采用 Kaplan-Meier 法评估总生存和无复发生存，采用 Log-rank 检验分析生存曲线之间的差异。连续变量表示为$\overline{x}\pm s$，采用 t 检验进行参数分析。分类变量采用卡方或 Fisher 确切检验分析。

结果

基于对整个研究的分析，结果表明，血浆 D-二聚体水平升高的患者平均年龄较大（58.69±8.32 岁比 63.05±8.44 岁，P<0.001），肿瘤较大（≥4cm，P=0.006），T 期较晚（P=0.024），N 期（P=0.041），肿瘤、淋巴结和转移（TNM）分期（P=0.029）和术后并发症（P=0.042）更常见。此外，根据 Cox 多因素分析的结果，术前血浆 D-二聚体水平升高不仅是总生存（风险比（HR）：1.430，95%置信区间（CI）（1.163-1.759），P=0.001）的独立预后因素，也是无复发生存（HR：1.236，95%CI（1.018-1.500），P=0.032）的独立预后因素。