Department of Laboratory Medicine, the Affiliated Hospital of Xuzhou Medical University, No. 99, Huaihai West Road, Quanshan District, Xuzhou, Jiangsu Province 221006, China; Department of Radiotherapy, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China.
Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200040, China.
Clin Chim Acta. 2024 Jun 15;560:119751. doi: 10.1016/j.cca.2024.119751. Epub 2024 Jun 1.
The metabolic or proliferative abnormalities that are characteristic of tumor cells can lead to abnormal fibrinolysis or coagulation system activity, with certain tumors exhibiting hypercoagulability or existing in a fibrinolytic state. However, the utility of biomarkers of coagulation and fibrinolysis when seeking to differentiate between benign gallbladder disease and malignant gallbladder tumors remains uncertain.
This study included a total of 81 patients with benign gallbladder polyps and 94 patients with malignant gallbladder tumors. Pre-biopsy or pretreatment levels of PT, APTT, FIB, D-dimer, FDP, PLT, PIC, TAT, TM, and t-PAIC from these patients were compared using Mann-Whitney tests. The baseline data of the patients were analyzed using chi-square tests, and the diagnostic utility of these biomarkers in distinguishing between benign and malignant gallbladder lesions was evaluated using ROC curves, and Spearman correlation analysis was employed to assess the correlation between these indicators and tumor parameters.
The average age of malignant gallbladder tumor group was higher than benign gallbladder polyp group. And the base line analysis showed that there was a statistic difference in age, history of smoking, drinking, biliary tract disease, BMI of over weight between these two groups. In patients with malignant gallbladder tumors, FIB, D-dimer, FDP, PIC, TAT, TM, and t-PAIC levels were significantly elevated relative to those in patients affected by benign gallbladder polyp. The AUC for FIB, D-dimer, and FDP was 0.8469, 0.6514, 0.5950, while for PIC, TAT, TM, t-PAIC and four biomarker combined diagnosed was 0.8455, 0.6554, 0.7130, 0.6806, and 0.8859. Among these, TM was associated with the vascular invasion of tumor patients; TAT and t-PAIC were associated with neural invasion; D-dimer and FDP were related to the maximum tumor diameter; and FDP had a certain correlation with the tumor stage.
In gallbladder tumor patients, conventional coagulation metrics like FIB, D-dimer, and FDP, as well as newer thrombotic indicators such as PIC, TAT, TM, and t-PAIC, were obviously increased. Correlations with tumor parameters suggested their potential as biomarkers to distinguish benign from malignant gallbladder growths.
肿瘤细胞的代谢或增殖异常可导致纤溶或凝血系统活性异常，某些肿瘤表现出高凝状态或处于纤溶状态。然而，在寻求区分良性胆囊疾病和恶性胆囊肿瘤时，凝血和纤溶标志物的效用仍然不确定。
本研究共纳入 81 例良性胆囊息肉患者和 94 例恶性胆囊肿瘤患者。采用 Mann-Whitney 检验比较这些患者术前或治疗前的 PT、APTT、FIB、D-二聚体、FDP、PLT、PIC、TAT、TM 和 t-PAIC 水平。采用卡方检验分析患者的基线数据，并采用 ROC 曲线评估这些标志物在区分良性和恶性胆囊病变中的诊断效用，采用 Spearman 相关分析评估这些指标与肿瘤参数的相关性。
恶性胆囊肿瘤组的平均年龄高于良性胆囊息肉组。基线分析显示，两组在年龄、吸烟史、饮酒史、胆道疾病、超重 BMI 方面存在统计学差异。与良性胆囊息肉患者相比，恶性胆囊肿瘤患者的 FIB、D-二聚体、FDP、PIC、TAT、TM 和 t-PAIC 水平显著升高。FIB、D-二聚体和 FDP 的 AUC 为 0.8469、0.6514、0.5950，而 PIC、TAT、TM、t-PAIC 和四项联合诊断的 AUC 为 0.8455、0.6554、0.7130、0.6806 和 0.8859。其中，TM 与肿瘤患者的血管侵犯有关；TAT 和 t-PAIC 与神经侵犯有关；D-二聚体和 FDP 与肿瘤最大直径有关；FDP 与肿瘤分期有一定相关性。
在胆囊肿瘤患者中，常规凝血指标如 FIB、D-二聚体和 FDP 以及新的血栓形成指标如 PIC、TAT、TM 和 t-PAIC 明显升高。与肿瘤参数的相关性提示它们有作为区分良性和恶性胆囊生长标志物的潜力。
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