[Analysis of the factors associated with abnormal coagulation and prognosis in patients with non-small cell lung cancer]

Abstract

Background and objective: The activation of coagulation and fibrinolysis is frequently encountered among cancer patients. Such tumors are associated with high risk of invasion, metastases, and negative final outcomes. Non-small cell lung cancer (NSCLC) accounts for approximately 80% to 85% of all lung malignancies. This study aims to investigate the prognostic value of blood coagulation tests for NSCLC and provide a reference to patients on the prevention and treatment of thrombophilia.

Methods: Data were collected from 604 cases of hospitalized patients with histologically confirmed NSCLC from January 2009 to December 2012 at the Fourth Hospital of Hebei Medical University. Data included the related indexes of coagulation function in patients before treatment [(i.e., prothrombin time (PT), prothrombin time activity (PTA), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-dimer, and platelet count)], as well as sex, age, pathological type, TNM stage, and lymph node status. Fifty control subjects without cancer were included in the analysis. Statistical analysis was conducted by using SPSS 13.0 software.

Results: The plasma level of all coagulation tests including D-dimer, Fib, PT, APTT, INR, and platelet counts revealed statistically significant differences between the patient and control group (P<0.001 for all variables; P=0.001,5 and P=0.004,5 for Fib and platelet counts, respectively). The squamous subtype exhibited high plasma Fib levels (P<0.001) compared with adenocarcinoma cell lung cancer patients. Fib and PLT levels increased (P<0.001 and P=0.014, respectively), and aPTT decreased (P<0.001) in patients at stages III and IV compared with those in patients at stages I and II. aPTT decreased significantly (P<0.001), and Fib and D-dimer levels increased (P<0.001 and P=0.048, respectively) in N1-3 patients with NSCLC compared with those of N0 patients. Prolonged PT and INR, high plasma Fib levels, and low PTA levels had statistically significant adverse effects on survival (P=0.032, P=0.001, P<0.001, and P=0.005, respectively). Multivariate analyses revealed that only increased INR was associated with a decreased survival rate in the related indexes of coagulation function (P=0.017).

Conclusions: Patients who have lung adenocarcinoma and/or lymph node metastasis at advanced stages of NSCLC are prone to thrombophilia. Prolonged PT and INR was associated with poor prognosis, and elevated INR was independently associated with a decreased survival rate. PT and INR are promising prognostic markers of NSCLC.

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不同PT水平NSCLC患者的总生存曲线 Overall survival curves in patients with NSCLC according to PT levels (P=0.032)

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不同INR水平NSCLC患者的总生存曲线 Overall survival curves in patients with NSCLC according to INR levels (P=0.001)

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不同纤维蛋白原水平NSCLC患者的总生存曲线 Overall survival curves in patients with NSCLC according to fibrinogen levels (P < 0.001)