| Background and PurposeAccording to the National Cancer Center,the latest data shows that,in China,the disease of cancer has become the first cause of death,morbidity and mortality rates are still rising,and it has become a very important public health issue.According to the latest cancer statistics shows China: The new cases of invasive cancer has made several4,292,000 in 2015,equivalent to an average of 12,000 cases of new-onset cancer every day,there are 2.814 million cancer deaths,equivalent to a daily average of 7,500 people die of cancer.Moreover,people have a poor prognosis and a shorter survival period of cancer contrast with the western,so it needs our efforts to focus on the precaution and treatments urgently.Early detection,early diagnosis,early treatment is the everlasting topic in hospital,and early detection is the essential of follow-up questions.Thus,how to diagnose cancer from the early detection of potential malignancy in all aspects has become the hotspot of current research.A number of studies reported in clinical practice and found that the blood of cancer patients generally in a hypercoagulable state,thrombosis prone to adverse events.Increased clotting activity leads to activation of the fibrinolytic system,the fibrinolytic process,urokinase-type plasminogen activator receptor(u-PAR)and inactive urokinase-type plasminogen activator precursor(Pro-u-PA)after binding it into an active urokinase-type plasminogen activator(u-PA),which can make plasminogen to plasmin,and thus degradation of fibrin,produce specific degradation products in fibrin degradation process that is D-dimer(D-dimer,DD),can be seen from the above,D-dimer is the only indicator reflects of thrombin and plasmin.The purpose of this experiment was to investigate whether there are differences in patients with malignant plasma in D-dimer levels compared to the normal population,as well as an assessment of whether malignant disease and cancer staging index,and how much significance it is.MethodsCollected 364 patients with malignant tumors(male 190 cases,female 174 cases)inJinan Fourth People’s Hospital from September 2013 to June 2015,according to the American Joint Committee on Cancer(AJCC,American Joint Committee on Cancer)developed TNM staging: stage Ⅰ is 67 cases,82 cases of stage Ⅱ,90 cases of stage Ⅲ,125 cases of stage Ⅳ.According to the site of tumor incidence inconsistent divided: 69 cases of breast cancer,61 cases of colorectal cancer,53 cases of lung cancer,47 cases of gastric cancer,19 cases of esophageal cancer,15 cases of thyroid cancer,15 cases of bladder cancer,14 cases of head and neck cancer,12 cases of ovarian cancer,11 cases of uterine cancer,,10 cases of renal cell carcinoma,10 cases of liver cancer,six cases of prostate cancer,the other 22 cases,Divided into 14 groups totally.And choose the healthy people 218 cases(male 120 cases,female 98 cases)in total at the same period as the control group.To draw their blood when limosis.With immuno nephelometry,determine the D-dimer in venous blood from the patient′s elbow on the following morning.All sample results for data analysis by SPSS18.0,count data were compared using chi-square test to compare the first test between the two samples were normal,with normal distribution of data applied two-sample t-test,non-normal distribution applied Mann-Whitney U test,we used one-way ANOVA to compare multiple-sample datas.To evaluate the significance of D-dimer which in the plasma in the diagnosis of cancer patients with the area under the ROC curve,and to find out the cut-off point,in order to assess their sensitivity and specificity at the cut-off point,we accept that it had statistical significance with P <0.05.The results1.To analyze the general data(age,gender)between the tumor and normal group,the gender composition of chi-square test,the two groups showed no significant difference(P>0.05);terms of age distribution by testing is non-normal distribution(P <0.01),applied Mann-Whitney U test shows no significant difference(P> 0.05).2.To analyze the content of plasma D-dimer between the tumor and normal group,they are non-normal distribution,apply Mann-Whitney U test showed significant differences(P = 0.00).3.According to the American Joint Committee on Cancer TNM stage(AJCC,American Joint Committee on Cancer),apply ANOVA to analyze the D-dimer between the normal group and stage Ⅰ、Ⅱ、Ⅲ、Ⅳ,the results are shown: the plasma D-dimer in stageⅢ and Ⅳ were significantly higher than the normal group,with a significant difference(P<0.05),when compared the rest of the group to the normal group there was no significantdifference.When compared the four different groups between each to each,only stage Ⅰwith stage Ⅳ 、 stage Ⅱ with stage Ⅳ have a significant difference(P <0.05).No difference between the other groups.4.According to the clinical practice,the TNM stage Ⅰ and Ⅱ patients were classified as early cancer group;the stage Ⅲ and Ⅳ patients were classified as late group.Mann-Whitney U test was used between the early group and the late group.It shows that the late group has a higher D-dimer levels than the early group,with significant difference(P <0.01).5.Apply ANOVA to analyze the D-dimer among different groups according to the site of tumor incidence inconsistent,the results are shown that there was a significant difference(P = 0.023)between lung cancer and breast cancer group,there was no difference among the other groups.Mann-Whitney U test was used to analyze the lung cancer group and the breast cancer group alone,the results showed: there was significant difference(P <0.01).6.Evaluation of the use of plasma D-dimer in the diagnosis of malignancy with receiver operating characteristic curve,the statistics show that: the area under the ROC curve(AUC)was 0.878,95% CI: 0.850 ~ 0.906,Youden index was 0.714.The maximum cutoff value is 1.624mg/L,the sensitivity was 71.4% and specificity was 99.5%.Conclusions1.The general Information of tumor and normal patients(age composition,gender distribution)has no significant difference when compared.2.The plasma D-dimer of tumor patients was significantly higher than the normal group,with statistical significance.3.According to TNM stage,plasma D-dimer in stage Ⅲ and Ⅳ were significantly higher than the normal group,stage Ⅰ and Ⅱ has no difference with the normal group.When compared between groups: plasma D-dimer in stage Ⅳ was significantly higher thanⅠ,Ⅱ period,it means the higher plasma D-dimer is the late stage the patients was.4.Plasma D-dimer in stage Ⅳ patients was significantly higher than stageⅠand Ⅱ.The plasma D-dimer of advanced cancer(stageⅢandⅣ)group was significantly higher than the early cancer(stageⅠandⅡ)group,with statistical significance.It means the late the clinical stage,the higher the plasma D-dimer,the worse the prognosis.5.Compared plasma D-dimer in different types of cancer,lung cancer group wassignificantly higher than that in the breast cancer group,but there was no significant difference among the other groups.It means lung cancer has a worse prognosis.6.D-dimer can be used to diagnose cancer;its cut-off value is 1.624mg/L,its sensitivity is 71.4%,specificity is 99.5%,can be used for clinical reference. |
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