CAJ | 학술논문

目的探讨接受根治性切除的结直肠癌患者术前血浆纤维蛋白原及D-二聚体水平与其临床病理特征及总生存率之间的关系.方法 2002年1月至2003年12月天津医科大学附属肿瘤医院接受根治性手术具备完整临床病理资料的结直肠癌患者341例,男178例,女163例,年龄58(23 ～90)岁,随访时间64(5 ～89)个月.检测患者术前的血浆纤维蛋白原及D-二聚体水平,观察总生存率,采用Log-rank检验进行单因素分析,Cox比例风险回归模型进行多因素分析,探讨二者与临床病理特征及总生存率之间的关系.结果 341例患者术前血浆纤维蛋白原水平为(3.7 ±0.7)g/L,D-二聚体为(0.49 ±0.18)mg/L.患者术前血浆纤维蛋白原水平与肿瘤分期、血管侵犯、术后远处转移和有无淋巴结转移均相关(均P ＜0.01),但与组织学分级和浸润深度均无关(P =0.232、0.253).患者5年生存率为64.5％(220/341).患者术前D-二.聚体水平与肿瘤分期、浸润深度和有无淋巴结转移均相关(P=0.013、0.007、0.001),但与组织学分级、血管侵犯和术后远处转移均无关(P=0.082、0.746、0.131),多因素分析显示术前纤维蛋白原水平(P=0.029)、组织学分级(P=0.001)和淋巴结转移(P =0.001)是独立的预后因子.结论结直肠癌患者术前纤维蛋白原和D-二聚体水平与病理分期相关,术前高纤维蛋白原水平与根治术后远处转移相关,总生存率较低,且是影响预后的独立因素.
목적 탐토접수근치성절제적결직장암환자술전혈장섬유단백원급D-이취체수평여기림상병리특정급총생존솔지간적관계.방법 2002년1월지2003년12월천진의과대학부속종류의원접수근치성수술구비완정림상병리자료적결직장암환자341례,남178례,녀163례,년령58(23 ～90)세,수방시간64(5 ～89)개월.검측환자술전적혈장섬유단백원급D-이취체수평,관찰총생존솔,채용Log-rank검험진행단인소분석,Cox비례풍험회귀모형진행다인소분석,탐토이자여림상병리특정급총생존솔지간적관계.결과 341례환자술전혈장섬유단백원수평위(3.7 ±0.7)g/L,D-이취체위(0.49 ±0.18)mg/L.환자술전혈장섬유단백원수평여종류분기、혈관침범、술후원처전이화유무림파결전이균상관(균P ＜0.01),단여조직학분급화침윤심도균무관(P =0.232、0.253).환자5년생존솔위64.5％(220/341).환자술전D-이.취체수평여종류분기、침윤심도화유무림파결전이균상관(P=0.013、0.007、0.001),단여조직학분급、혈관침범화술후원처전이균무관(P=0.082、0.746、0.131),다인소분석현시술전섬유단백원수평(P=0.029)、조직학분급(P=0.001)화림파결전이(P =0.001)시독립적예후인자.결론 결직장암환자술전섬유단백원화D-이취체수평여병리분기상관,술전고섬유단백원수평여근치술후원처전이상관,총생존솔교저,차시영향예후적독립인소.
Objective To explore the associations of preoperative plasma levels of fibrinogen and D-dimer with clinicopathologic parameters and overall survival in colorectal cancer patients after curative resection.Methods From January 2002 to December 2003,a total of 341 colorectal cancer patients underwent curative resection.And their relevant clinical data were reviewed.The median age was 58 years (range:23-90 years) and the median follow-up period was 64 months (range:5-89 months).The preoperative plasma levels of fibrinogen and D-dimer were examined,the correlation of clinicopathologic findings and overall survival was analyzed.A Log-rank test was used for univariate analysis and a Cox regression model for multivariate analysis.Results The preoperative plasma levels of fibrinogen and D-dimer were (3.7 ±0.7)g/L and (0.49 ±0.18) mg/L respectively.Elevated plasma levels of fibrinogen were associated with advanced tumor stage (P =0.008),venous invasion (P =0.006),postoperative distant metastases (P ＜ 0.01) and lymph node involvement (P =0.001),but not with histologic grade (P =0.232),and invasion depth (P =0.253).The overall survial is 64.5％ (220/341).Elevated plasma levels of D-dimer were associated with advanced tumor stage (P =0.013),invasion depth (P =0.007) and lymph node involvement (P =0.001),but not with histologic grade (P =0.082),venous invasion (P =0.746) or postoperative distant metastases (P =0.131).Multivariate analysis showed that preoperative plasma levels of fibrinogen (P =0.029),histologic grade (P =0.001),and lymph node involvement (P =0.001) were independent prognostic factors.Conclusions High preoperative plasma levels of fibrinogen and D-dimer are associated with clinicopathologic parameters.And a high preoperative plasma level of fibrinogen is associated with distant metastases and poor prognosis after curative resection in colorectal cancer patients.