Clinical Analysis Of Prognosis And Risk Factors In Lung Cancer Patients With Venous Thromboembolism

Objective: There is a close link between cancer with venous thromboembolism and platelet activation,cancer triggers a series of platelet activation reactions leading to blood clotting hypercoagulable state and thus the formation embolism,or platelet activation itself also factors leading to blood is hypercoagulable state,also No entirely clear explanation,there is interaction between cancer and platelets.Blood hyper-coagulable state is the basis of the occure of the venous thromboembolism malignancy.There are many Mechanism and Causes of cancer cause hypercoagulable states,including malignant tumors on platelet activation and secretion of procoagulant tissue factor(TF)and cancer procoagulant substance(CP)activate coagulation.Malignant tumor cells themselves have the ability to activate platelets and induce platelet aggregation,a phenomenon known as "cancer-induced platelet aggregation",which lead to a hypercoagulable state.While platelet activating formation of circulating tumor cells,survival,and metastasis anchor also played a role in the protection and facilities provided,hypercoagulable state cancer patients not only predispose patients to thrombosis,but also conducive to tumor cells growth and metastasis.In particular,peripheral blood released from the primary tumor or metastases into the blood,tumor-specific antigens or genetic characteristics of circulating tumor cells(CTCs)is the source of tumor recurrence and metastasis,but also lead to malignant peripheral blood in a hypercoagulable reason states.Hypercoagulable state and tumor recurrence,metastasis of a direct impact on the prognosis of patients.Thrombotic diseases is the second biggest cause of death among the cancer patient,because the blood hypercoagulable state can promote cancer recurrence and metastasis,and cancer in its invasion and metastasis can also promote thrombosis,venous thromboembolism so more tips tumor patients with a poor prognosis.The incidence of malignant tumors in patients with venous thromboembolism is significantly higher than the general population,including lung cancer,pancreatic cancer,gastrointestinal cancer,ovarian cancer,with the highest incidence of lung cancer,and lung cancer is the world’s highest morbidity and mortality malignant tumor.Lung cancer through multiple mechanisms of action destroy the dynamic balance in the body between coagulation and anticoagulation,thereby enabling the body hypercoagulable state,and even the formation of embolism,lung cancer with the incidence of venous thromboembolism and staging will be based on different pathological types of lung cancer different,not only lung cancer with venous thrombosis and cancer growth,invasion,anchor,transfer and other factors related to the tumor itself,but also the discharge and other chemotherapy,surgery and brake factors.Studies have reported that the prognosis of patients with lung cancer with venous thrombosis in patients with lung cancer are worse than simple,although in recent years,with the rising occurrence of lung cancer rates,the proportion of lung cancer with venous thromboembolism showed an increasing trend,but lung cancer with the incidence of venous thromboembolism the risk factors and the occurrence and development mechanisms are not yet fully understood,lung cancer with VTE prognosis is for further study elucidated.The present study was designed to retrospectively analyzed lung cancer combined venous thromboembolism clinical risk factors and prognosis,more in-depth understanding of the impact of lung cancer with clinical features of venous thromboembolism,and platelet lung cancer combined venous thromb-oembolism formation.Methods: The study collected from September 2005 to September 2015,the first visit to the clinical data Fourth Hospital of Hebei Medical University,73 cases of lung cancer and 229 cases of the same period in the absence of venous thromboembolism in patients with lung cancer were analyzed retrospectively.229 cases of lung cancer patients on admission were confirmed by lung CT examination,B-ultrasound vascular,blood and other tests,the possibility of merging the exclusion of venous thromboembolism.The combined information content of venous thromboembolism in patients with leukemia group including simple merger of venous thromboembolism in patients with lung cancer,which includes two sets of blood-related indicators relevant indicators(including white blood cell count,neutrophil count,hemoglobin count,platelet count)coagulation The relative parameters(including D-dimer,PT,INR,APTT,FIB,TT,FDP,AT-Ⅲ),fibrinogen,carcinoembryonic antigen,neuron-specific enolase,gender,age,BMI values,smoking,drinking history,past medical history,pathology TNM stage,whether central venous catheterization confirmed VTE diagnosis is based and the like.Follow-up mode for the telephone interview,outpatient require and hospitalization collection.All patients were followed up until December 31,2015,clinical data to establish a database of all patients,factors affecting lung embolism merger analysis,using univariate and multivariate logistic regression analysis,using kaplan-meier analysis simple lung cancer and lung cancer survival time difference combined venous thromboembolism group,and the use of multivariate COX survival analysis method for analysis,P <0.05 was considered statistically significant.All data analysis using spss 21.0 statistical software.Results: Univariate logistic regression analysis,the risk factors for lung cancer staging merge embolism,staging lung cancer with higher VTE risk,the higher the points,OR value of 2.284(P = 0.001);leukocytosis increased risk of lung cancer with VTE,OR value to 5.588(P <0.001);hemoglobin factors of lung cancer with VTE,the combined VTE hemoglobin increased risk of lung cancer decreases,OR value of 0.173(P <0.001);platelet lung embolism combined factors,platelet elevated lung cancer the combined VTE risk reduction,OR value of 2.193(P = 0.001);D-dimer lung embolism combined factors,D-dimer increased risk of lung cancer with VTE is increased,OR value of 15.945(P <0.001);PT as affecting factors of lung cancer combined embolization,increases the risk of lung cancer with increased PT of VTE,OR value of 22.733(P <0.001);INR lung consolidation VTE factors,INR increased risk of lung cancer with VTE increased,OR value to 24.783(P <0.001);APTT of lung cancer combined factors of VTE,APTT increased risk of lung cancer with VTE increased,OR value of 2.262(P = 0.006);TT lung embolism combined factors,TT increased lung cancer the combined increased risk of VTE,OR value of 3.864(P <0.001).Fibrinogen as factors of lung cancer with VTE,OR value of 4.276(P <0.00),increased levels of fibrinogen,lung cancer with an increased risk of venous thromboembolism;reduce the risk level AT-Ⅲ increased lung cancer with VTE,OR = 0.084(P <0.001).Multivariate factors of lung embolism combined analysis of gender,age,BMI values,smoking,alcohol consumption,history of disease,staging surgery,white blood cells,hemoglobin,platelet D-dimer,PT,INR,APTT,TT,AT-Ⅲ,carcinoembryonic antigen,neuron-specific enolase as independent variables,whether to merge lung embolism is a solid variable,logisitc regression analysis showed: white blood cells,hemoglobin,platelets,D-dimer,PT,AT-ⅲ lung consolidation independent factors embolism.The risk of lung cancer with VTE leukocytosis increased OR = 4.434(P = 0.037);hemoglobin increased risk of lung cancer with VTE decreased,OR value of 0.196(P = 0.001);the risk of lung cancer with thrombocytosis VTE increased,OR value 2.238(P = 0.0036);D-dimer increased risk of lung cancer with VTE increased,OR value of 11.073(P = 0.010);PT increased risk of lung cancer with VTE increased,OR value of 12.233(P = 0.008);fibrin increasing the original level,increase the risk of lung cancer with VTE occurred,OR value of 11.104(P <0.001);the risk of AT-ⅲ increased lung cancer with VTE decreased,OR value of 0.04(P = 0.003).Survival analysisAlone lung cancer median survival time was 15 months,and lung cancer with embolization group median survival time was 7 months,the two groups was statistically significant(χ2 = 132.701,P<0.001).COX proportional hazards regression analysis using multivariate survival analysis,leukocytes,and PT increased D-dimer levels and reduced hemoglobin levels were independently associated with a worse prognosis.Conclusions:1 lung cancer with VTE patients,adenocarcinoma is the most common histological type and the greater the probability of the occurrence of the later stages of VTE.2 platelets,increased D-dimer,fibrinogen levels,PT,TT prolonged and hemoglobin,and decreased levels of AT-Ⅲ lung cancer with VTE is closely related independent factors.3 APTT is prolonged lung cancer with VTE risk factors,but it is not an independent risk factor for lung cancer with VTE.4 white blood cells,and PT increased D-dimer levels and reduced hemoglobin levels were independently associated with a worse prognosis.5 Lung cancer alone group,the median survival time was 15 months,and lung cancer with VTE median survival time was 7 months,patients with lung cancer with VTE was significantly lower than the survival time of patients with lung cancer alone,the combined VTE in patients with lung cancer prognosis than lung cancer alone the group of patients with poor prognosis.