Tupikowski Krzysztof, Jaobsche-Policht Urszula, Bittner Jadwiga, Ptaszkowski Kuba, Halon Agnieszka, Zdrojowy Romuald, Adamiec Rajmund, Gosk-Bierska Izabela
Subdivision of Urology, Wroclaw Comprehensive Cancer Centre, Wroclaw, Poland.
Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland.
Arch Med Sci. 2021 Apr 8;19(4):1003-1010. doi: 10.5114/aoms/128845. eCollection 2023.
Multiple studies suggest that cancer leads to activation of clotting and fibrinolysis pathways, elevating the risk of thromboembolic events. Kidney cancer is often complicated by clotting disorders. In this study, we hypothesized that preoperative clotting and fibrinolysis parameters are altered in healthy volunteers and kidney tumor patients. We also hypothesized that these differences may be associated with survival in patients who have undergone operations due to kidney tumors.
In this study, 96 patients with kidney tumors and 30 healthy volunteers were recruited at a single university center. All patients were assessed for pre-operative serum concentrations of tissue factor (TF), tissue factor pathway inhibitor (TFPI, total TFPI, full-length TFPI, truncated TFPI), plasmin-antiplasmin complex (PAP), thrombin-antithrombin complex (TAT), von Willebrand factor (vWF), clotting factor XIII A1 (FXIIIA1), D-dimers, and fibrinogen. Additionally, standard peripheral blood morphology was evaluated.
Malignant kidney tumors were diagnosed in 85 of 96 tumor patients. In patients with kidney tumors, there were statistically significantly higher concentrations of fibrinogen, D-dimers, TAT, PAF, TF, TFPI, vWF, FXIIIA1, and leukocyte counts compared to the control group. Statistically significant correlations were found between multiple parameters. This points to significant clotting system alterations. Cox stepwise hazard analysis showed that pre-operative fibrinogen and D-Dimer concentrations were significantly associated with survival.
In patients with kidney tumors, multiple clotting and fibrinolysis parameters are significantly altered. Routine pre-operative measures should include determination of fibrinogen and D-dimer concentrations as these markers aid in prediction of survival probability.
多项研究表明，癌症会导致凝血和纤维蛋白溶解途径的激活，增加血栓栓塞事件的风险。肾癌常伴有凝血障碍。在本研究中，我们假设健康志愿者和肾肿瘤患者的术前凝血和纤维蛋白溶解参数会发生改变。我们还假设这些差异可能与因肾肿瘤接受手术的患者的生存率有关。
在本研究中，一所大学中心招募了96例肾肿瘤患者和30名健康志愿者。所有患者均接受术前血清组织因子（TF）、组织因子途径抑制剂（TFPI，总TFPI、全长TFPI、截短TFPI）、纤溶酶 - 抗纤溶酶复合物（PAP）、凝血酶 - 抗凝血酶复合物（TAT）、血管性血友病因子（vWF）、凝血因子XIII A1（FXIIIA1）、D - 二聚体和纤维蛋白原浓度的评估。此外，还评估了标准外周血形态。
96例肿瘤患者中有85例被诊断为恶性肾肿瘤。与对照组相比，肾肿瘤患者的纤维蛋白原、D - 二聚体、TAT、PAF、TF、TFPI、vWF、FXIIIA1浓度及白细胞计数在统计学上显著更高。多个参数之间存在统计学上的显著相关性。这表明凝血系统发生了显著改变。Cox逐步风险分析表明，术前纤维蛋白原和D - 二聚体浓度与生存率显著相关。
肾肿瘤患者的多个凝血和纤维蛋白溶解参数发生了显著改变。常规术前检查应包括测定纤维蛋白原和D - 二聚体浓度，因为这些标志物有助于预测生存概率。
