| Background The incidence and mortality of malignant tumors are increasing gradually,and the number of deaths caused by malignant tumors accounts for about 25% of the total number of deaths every year in China,which has become the leading cause of death in patients with malignant tumors.Most of the patients were found to be at a later stage,with distant metastasis and easy to combine with thrombotic disease.Most of the studies on D-dimer and tumor markers are focused on the diagnosis and evaluation of tumor,Single event detection is related to tumor metastasis and thrombosis,and no diagnostic value has been found related to advanced tumor metastasis and thrombosis.Accordingly,we combined D-dimer with tumor markers to explore its clinical significance.Objective Investigate the clinical significance of combined detection of plasma D-dimer(D-D)and tumor markers(CA19-9,CAl25,CEA)in patients with advanced cancer,in order to find out its relationship with metastasis,thrombosis,and recent effects,so we can find out the relationship between metastasis,thrombosis and short-term curative effect to determine the predictive value of D-dimer and tumor markers in tumor metastasis and thrombosis,and to provide help for the diagnosis and treatment of malignant tumors.Methods The study was divided into three groups: tumor group,control group and normal group.The tumor group contained 211 cases of malignant tumor,which were selected from the cancer center of Wuyang People’s Hospital from July 2012 to July 2016,all patients diagnosed by pathological examination in patients with malignant tumor,and these tumorpatients were set as tumor group.According to the AJCC staging criteria for stage III~IV patients,including 115 cases of male patients,96 female patients,mean age 58.69±9.56 years,including lung cancer in 72 cases,esophageal cancer in 53 cases,gastric cancer in 47 cases,colon cancer in 39 cases were studied.The control group consisted of 60 patients with primary malignant tumor treated by the first phase of IB ~ II in the same period,including 37 cases of male patients,23 female patients,mean age 61±9.38 years,including 21 cases of lung cancer,14 cases of esophageal carcinoma,14 cases of gastric cancer,11 cases of colon cancer.The normal group contained 50 cases of physical examination in the same period including 26 males and 24 females,with an average age of 57.2±16.08 years old.There was no significant difference between the three groups in gender,age and tumor location(P>0.05).Determination of peripheral blood of patients admitted to hospital eighteenth days before treatment,after 2 cycles of chemotherapy in D-dimer(D-D)respectively,tumor markers(CA19-9,CAl25,CEA)level,and records of patients with general information,clinical case data,using SPSS22.0 statistical software for statistical analysis of all data.Measurement data using X±S and according to the overall situation and distribution homogeneity of variance t test or Wilcoxon rank sum test or Kruskal Wallis test;categorical data using chi square test;The curves of D-dimer,tumor markers and thrombosis and tumor metastasis were plotted by receiver operating curve(Receiver operator characteristic curve,ROC curve),in order to evaluate the individual and combined detection of thrombosis and tumor metastasis prediction value,find out the sensitivity and specificity of the best diagnostic cut-off value.Results 1.Expression of D-dimer and tumor markers: The average level of tumor group D-dimer,CA19-9,CA125 and CEA were significantly higher than the control group and the normal group,the control group was higher than that of the normal group,the difference was statistically significant(P<0.05);but between different parts of advanced cancer tumor D-dimer and tumor markers are similar,the difference was not statistically significant(P>0.05).2.Efficacy evaluation: After chemotherapy,there were 21 cases of complete remission,partial remission in 59 cases,stable disease in the 74 cases,deterioration of the disease in the 57 cases,effective rate was 37.9% after 2 cycles chemotherapy,control rate of disease was 72.9%.The D-dimer,CA19-9,CA125 and CEA levels in the effective group and stable group after chemotherapy were significantly lower than those before chemotherapy,and the level of the progression group was higher than that of before chemotherapy,the difference was statistically significant(P < 0.05).3.The consiqunce of thrombus : 211 cases of patients with thrombotic disease in 19 cases,including deep vein thrombosis in the lower extremities in 8 cases,with cerebral infarction in 7 cases,myocardial infarction in 2 cases,subclavian vein thrombosis in 1 cases(9 cases).The plasma levels of D-dimer,CA19-9,CA125 and CEA were significantly higher in the thrombus group than those in the non thrombosis group(P < 0.05).4.Prediction of metastasis by D-dimer and tumor markers:The ROC curve of D-dimers,CA199,CA125 and CEA in the prediction of distant metastasis of the tumor under the area were0.765、0.724、0.705、0.763,and the diagnostic cut-off values were 1.25mg/L,95U/ml,73U/ml,31.5ng/ml,The sensitivity of the four items was low,and the sensitivity and specificity of the four parallel joint detection were 84% and 80%.5.D-dimer and tumor markers predict thrombosis: D-dimer,CA19-9,CA125 and CEA prediction ROC curve area of advanced cancer patients with thrombotic diseases under respectively 0.835,0.707,0.775,0.713,the diagnostic cut-off values were 2.57mg/L,131.95U/ml,104.43U/ml,45.74ng/ml,single detection sensitivity and specificity were 89% and 69%,74% and 70%,82% and 71%.69% and 76%,the four parallel combination of detection sensitivity and specificity were 94% and 65%.Conclusions 1.The levels of D-dimer,CA19-9,CA125 and CEA in plasma of patients with advanced cancer were significantly higher than those in the early stage.2.The plasma levels of D-dimer,CA19-9,CA125 and CEA in the patients with advanced cancer were not related to the location of the tumor.3.Combined detection of D-dimer,CA19-9,CA125 and CEA is helpful to evaluate the efficacy of chemotherapy in patients with advanced stage.4.D-dimer combined with CA19-9,CA125,CEA detection has certain predictive value for tumor metastasis and thrombosis. |
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