Combination of preoperative fibrinogen and D-dimer as a prognostic indicator in pancreatic ductal adenocarcinoma patients undergoing R0 resection

被引：14

作者：

Zhang, Li-Peng ^{[1
]}

Ren, Hu ^{[1
]}

Du, Yong-Xing ^{[1
]}

Zheng, Xiao-Hao ^{[1
]}

Zhang, Zong-Ming ^{[2
]}

Wang, Cheng-Feng ^{[1
,3
]}

机构：

[1] Chinese Acad Med Sci & Peking Union Med Coll, Dept Pancreat & Gastr Surg, Natl Canc Ctr, Natl Clin Res Ctr Canc,Canc Hosp, 17 Panjiayuan Nanli, Beijing 100021, Peoples R China

[2] Capital Med Univ, Dept Gen Surg, Beijing Elect Power Hosp, State Grid Corp China, Beijing 100073, Peoples R China

[3] Chinese Acad Med Sci & Peking Union Med Coll, State Key Lab Mol Oncol, Natl Canc Ctr, Natl Clin Res Ctr Canc,Canc Hosp, Beijing 100021, Peoples R China

来源：

WORLD JOURNAL OF GASTROINTESTINAL SURGERY | 2021年 / 13卷 / 03期

基金：

中国国家自然科学基金;

关键词：

Pancreatic ductal adenocarcinoma; R0; resection; Fibrinogen; D-dimer; Prognosis; Survival; MOLECULAR-WEIGHT HEPARIN; PRETREATMENT PLASMA-FIBRINOGEN; VENOUS THROMBOEMBOLISM; POOR-PROGNOSIS; GROWTH-FACTORS; CANCER; SURVIVAL; INFLAMMATION; PREDICTS; CORRELATE;

D O I：

10.4240/wjgs.v13.i3.279

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

BACKGROUND 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. AIM To explore the prognostic significance of fibrinogen combined with D dimer in pancreatic ductal adenocarcinoma (PDAC) patients undergoing radical R0 resection. METHODS 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. RESULTS 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, P = 0.001) and preoperative D-dimer concentration (HR: 1.355, 95%CI: 1.019-1.801, P = 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 (P < 0.001), lymph node metastasis (HR: 0.663, 95%CI: 0.497-0.883, P = 0.005), preoperative CA19-9 level (HR: 1.699, 95%CI: 1.258-2.293, P = 0.001), adjuvant therapy (HR: 1.582, 95%CI: 1.202-2.081, P = 0.001) and preoperative combined grouping (HR: 2.397, 95%CI: 1.723-3.335, P < 0.001) were independent predictors of OS in PDAC patients undergoing radical R0 resection. CONCLUSION 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.

引用

页数：25