The D-dimer’s Clinical Value In The Diagnosis Of The Pancreatic Cancer

BackgroundThe pancreatic cancer is one of the malignant tumors which have the highest mortality rates in the gastrointestinal tract. The statistics showed the5year’s survival rate of the pancreatic cancer only rose to4%in2004, which was3%in the1970s.In2009, the statistics from the American cancer society showed that the United States had42470patients newly diagnosed cancer cases, and in which there were35240patients died of the pancreatic cancer, and the mortality was the fourth. The pancreatic cancer has an increasing incidence in recent years. It occurs in people over the age of40, and the etiology is unknown.Smoking, diet, diabetes, pancreatitis and carcinogenic substance may be relevant. In the early days the patients lack typical clinical manifestations, and when they appear symptoms, it is late. Studies show that if the tumor is<1cm, in the early line after radical surgery,5year’s survival rate is100%, and it is visible to improve survival rates, focusing on the early diagnosis. CA199is the tumor marker, which has the highest sensitivity and has the most extensive clinical application in the pancreatic cancer.Its sensitivity and specific degree are80%and73%, respectively. But in recent years, some study has shown that CA199is not suitable for asymptomatic patients with pancreatic cancer in early screening. Once the study showed that CA242’s sensitivity have no statistics difference compared to CA199, but the specific degree is higher than CA199.The liver function and the bile don’t effect the expression for the CA242, and it can be used as the important supplement for CA199. The d-dimer is the degradation product from the scross linking fiber proteins, which is the specificity of the index about secondary fibrinolysis. In the digestive tract tumors the d-dimer is almost not normal. The d-dimer’s clinical significance in the stomach, liver, colorectal cancer, esophageal are much researched, but the study is less about the d-dimer’s clinical significance in the pancreatic cancer. The purpose of this study is that through the analysis about clinical data from50cases of pancreatic cancer patients and50cases of the control group, this paper discusses the d-dimer’s clinical value in the diagnosis and treatment of the pancreatic cancer, and discusses the sensitivity and specificity about the d-dimer, CA199, CA242to find effective combination of diagnosis scheme to early detect of pancreatic cancer, and to improve the survival rate.Methods Choose50patients from January2006to January2012,who are diagnosed in our hospital for the pancreatic cancer.They will be divided into two groups, and one group without lymph node and distant metastasis (Ⅰ period+ⅡA period), is11patients, and the other group with lymph node or distant metastasis (ⅡB period Ⅲ period Ⅳ++period) is39cases. Choose50cases from the benign lesions (including pancreatitis, pancreatic cysts, bravery manager, etc) as a control group. The researchers are not taking any anticlotting drugs, and also do not have any coagulant function abnormality diseases such as hypertension, diabetes, hepatitis, coronary heart disease, embolism of deep vein in sickness and so on.The researchers are collected the clinical data and are retrospectively analyzed. Analyze the d-dimer’s mean, standard deviation, mean differences betweeen the pancreatic cancer group and the control group, and mean differences betweeen the group without lymph node and distant metastasis and the group with lymph node or distant metastasis using SPSS13.0.At the same time calculate the sensitivity, specific degrees and Youden’s index of the d-dimer, CA199, CA242, and analyze the change after the united test.ResultIn the control grow the d-dimer’s mean and standard deviation are (232.35123.56) ug/L, and in the pancreatic cancer group they are (677.92585.16) ug/L. The differences are tatistically significant (t=5.26, P<0.05).The d-dimer’s median is337.00ug/L, and four points digits spacing (P75-P25) is343.92ug/L in the group without lymph node and distant metastasis, and the other is513.60ug/L,640.50ug/L, which is higher than the group without lymph node and distant metastasis. The difference between the two groups was statistically significant (Z=2.178, P=0.029, P<0.05).In the patients with pancreatic cancer the specificity of the d-dimer, CA199, CA242are84%,78%and78%respectively, and the d-dimer’s sensitivity is the highest. The specific degrees are43%,50%and57%respectively. After the d-dimer unitied CA242or CA199the specific degrees rise to71%, and the sensitivity decline to68%. But the diagnosis accuracy increases, and is higher than CA242+CA199.The d-dimer unitied CA242or CA199can increase diagnosis rate, and can be used as a auxiliary examination for the early diagnosis of the pancreatic cancer.ConclusionIn the pancreatic cancer, the d-dimer rises obviously, and especially with the lymph node or distant metastasis for pancreatic cancer patients the d-dimer rises more obviously. The d-dimer’s sensitivity is the higher than CA199or CA242.The d-dimer unitied CA242or CA199can increase diagnosis rate, and can be used as a auxiliary examination for the early diagnosis of pancreatic cancer. At the same time because the d-dimer’s detection is simple, convenient, quick, easy in clinical promotion, it has very high value of clinical application.