凝血指标预测立体定向治疗NSCLC脑转移疗效

Coagulation index predicts disease progression in patients with NSCLC and brain metastases after stereotactic radio surgery

    摘要
  • 摘要:
    目的 分析凝血指标对非小细胞肺癌（non-small cell lung cancer，NSCLC）脑转移患者立体定向放射外科（stereotactic radio surgery，SRS）治疗预后的预测价值。
    方法 回顾性收集2015年10月至2018年9月在天津市环湖医院确诊为NSCLC脑转移并行SRS治疗的512例患者临床资料，分析总体生存（overall survival，OS）率与无进展生存（progression-free survival，PFS）率，运用Cox多因素分析影响预后相关因素，并基于Cox多因素分析绘制工作特征（receiver operating characteristic，ROC）曲线，运用曲线下面积（area under the ROC curve，AUC）分析凝血指标对NSCLC脑转移行SRS治疗患者预后的预测价值。
    结果 1、2、3、4年的PFS分别为79.9%、69.9%、56.6%、43.2%，OS分别为93.4%、83.2%、69.9%、57.6%。吸烟、纤维蛋白原（fibrinogen，Fib）<3.22 g/L、凝血酶原时间（prothrombin time，PT）<11.69 s、D-二聚体（D-dimer，D-D）<0.51 μg/L与较长的PFS率相关（P<0.05）；活化部分凝血活酶时间（activated partial thromboplastin time，APTT）<21.05 s、Fib<3.22 g/L、D-D<0.51 μg/mL与较长的OS率相关（P<0.05）。吸烟、Fib<3.22 g/L、D-D<0.51 μg/mL与较长的PFS率显著相关（P<0.05）；Fib<3.22 g/L、D-D<0.51 μg/mL与较长的OS率显著相关（P<0.05）。Fib与D-D联合检测预测NSCLC脑转移患者SRS治疗预后的AUC显著高于Fib与D-D单独检测（P<0.05）。
    结论 凝血指标与SRS治疗的NSCLC脑转移患者预后有一定相关性，Fib与D-D为患者预后独立危险因素，可用于评估其预后，两组指标联合评估价值可能更优，具有进一步深入研究的价值。

     

    Abstract:
    Objective To analyze the prognostic value of the coagulation index in stereotactic radio surgery (SRS) for patients with non-small cell lung cancer (NSCLC) and brain metastases (BMS).
    Methods We retrospectively analyzed clinical data from 512 patients diagnosed with NSCLC and BMS, who were treated with SRS at Tianjin Huanhu Hospital from October 2015 to September 2018. The overall survival (OS) and progression-free survival (PFS) rates were analyzed. The Cox model was employed to examine prognostic factors. Subsequently, the receiver operating characteristic (ROC) curve was constructed based on multi-factor analysis usin the Cox model. The area under the ROC curve (AUC) was used to assess the prognostic value of coagulation indexes in patients with NSCLC and BMS who underwent SRS.
    Results In 1, 2, 3, and 4 years, PFS rates were 79.9%, 69.9%, 56.6%, and 43.2%, respectively, and OS rates were 93.4%, 83.2%, 69.9%, and 57.6%, respectively. Smoking and average fibrinogen (Fib) levels, prothrombin time (PT), and D-dimer (D-D) levels were correlated with a longer PFS (P<0.05). Average activated partial thromboplastin time (APTT), Fib, and D-D levels were correlated with a longer OS (P<0.05). Smoking and mean Fib and D-D levels were significantly correlated with a longer PFS (P<0.05), while The average levels of Fib and D-D are each significantly associated with longer OS rates (P<0.05). The combined detection of Fib and D-D in predicting the prognosis of NSCLC patients with brain metastases undergoing SRS treatment shows a significantly higher AUC compared to the detection of Fib and D-D individually (P<0.05).
    Conclusions Coagulation indexes have a certain correlation with the prognosis of patients with NSCLC and BMS treated with SRS. Furthermore Fib and D-D are independent risk factors for the prognosis of these patients and can be used to assess their outcomes. The combined evaluation of the indexes provides a more ideal prognostic assessment.

     

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