文章摘要

术前D-二聚体及纤维蛋白原含量与胃肠道间质瘤患者预后的关系

作者: 1,2蔡华霞, 1王曙逢
1 西安交通大学第一附属医院 普通外科，陕西 西安710061
2 西安一四一医院 普通外科，陕西 西安 710089
通讯: 王曙逢 Email: dawn@mail.xjtu.edu.cn
DOI: 10.3978/.10.3978/j.issn.1005-6947.2017.04.007

摘要

目的：探讨术前血浆D-二聚体（D-D）及纤维蛋白原含量（FIB）对胃肠道间质瘤（GIST）患者术后预后的预测价值。方法：收集2010年1月—2015年12月手术治疗的170例GIST患者临床病理及随访资料，分析术前D-D及FIB水平与患者预后的关系。结果：170例GIST患者中男91例，女79例；多见于50~70岁年龄段；肿瘤原发部位最常见于胃（122例，71.8%），其次为小肠（34例，20.0%）。全组术后3、5年无复发生存率（RFS）分别为85%、75%。以生存结局（出现转移或复发）为状态变量的ROC曲线显示，D-D与FIB的最佳截点值分别为
1.24 mg/L、3.24 g/L。单因素分析显示，D-D≥1.24 mg/L、FIB≥3.24 g/L、NIH危险度分级中高危、肿瘤直径>5 cm及胃以外部位肿瘤均与GIST患者术后3、5年RFS降低有关（均P<0.05）；多因素分析显示，D-D（RR=0.382，95% CI=0.151~0.967，P=0.042）、FIB（RR=0.123，95% CI=0.035~0.430，P=0.001）、肿瘤NIH危险度分级（RR=0.149，95% CI=0.042~0.524，P=0.003）是影响GIST患者术后预后的独立危险因素。GIST患者NIH危险度分级与D-D、FIB之间均存在明显相关性（r=0.648、0.868，均P<0.01）。结论：术前血浆D-D及FIB可作为预测GIST患者术后预后的参考指标。
关键词： 胃肠道间质肿瘤 纤维蛋白原 纤维蛋白纤维蛋白原降解物 预后

Association of preoperative plasma levels of D-dimer and fibrinogen with prognosis of patients with gastrointestinal stromal tumor

Authors: 1,2CAI Huaxia, 1WANG Shufeng
1 Department of General Surgery, the First Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710061, China
2 Department of General Surgery, Xi’an 141 Hospital, Xi’an 710089, China

CorrespondingAuthor:WANG Shufeng Email: dawn@mail.xjtu.edu.cn

Abstract

Objective: To investigate the value of preoperative plasma levels of D-dimer (D-D) and fibrinogen (FIB) in predicting the postoperative prognosis of patients with gastrointestinal stromal tumor (GIST). Methods: The clinicopathologic and follow-up data of patients with GIST undergoing surgical treatment from January 2010 to December 2015 were collected. The relations of preoperative D-D and FIB levels with the prognosis of patients were analyzed. Results: Of the 170 GIST patients, 91 cases were male and 79 cases were female, ages mainly ranged from 50 to 70 years, and the primary tumors were mostly located in the stomach (122 cases, 71.8%) followed by the small intestine (34 cases, 20.0%). The 3- and 5-year recurrence free survival rate (RFS) of the entire group was 85% and 75%, respectively. The ROC curves with survival outcome (occurrence of metastasis or recurrence) as state variable demonstrated that the optimal cut-off point for D-D and FIB was 1.24 mg/L and 3.24 g/L, respectively. Univariate analysis showed that D-D≥1.24 mg/L, FIB≥3.24 g/L, moderate and high NIH risk categories, tumor diameter greater than 5 cm, and extra-gastric location were significantly associated with the reduced postoperative 3- and 5-year RFS of GIST patients (all P<0.05); multivariate analysis revealed that D-D (RR=0.382, 95% CI=0.151–0.967, P=0.042), FIB (RR=0.123, 95% CI=0.035–0.430, P=0.001) and tumor NIH risk category (RR=0.149, 95% CI=0.042–0.524, P=0.003) were independent risk factors for postoperative prognosis of GIST patients. There was significant correlation between tumor NIH risk category and either D-D or FIB in GIST patients (r=0.648; 0.868, both P<0.01). Conclusion: Preoperative plasma levels of D-D and FIB can potentially be used as predictors for postoperative outcome of GIST patients.
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