| Background and objective:The incidence of lung cancer remains high,and most patients are staged III or IV at the time of treatment.Chemotherapy is the main choice of palliative therapy for these patients.With the f of the failure chemotherapy,most patients will be diagnosed with a progrive disease.The assessment of the efficacy of chemotherapy plays an important role in the development of treatment options for lung cancer patients.Currently evaluation criteria for solid tumor(RECIST)is still the main basis for evaluating the efficacy of lung cancer.The RECIST standard does not recommend the use of serum tumor markers alone for efficacy evaluation and requires imaging studies.Although there have been many studies in the past,blood tumor markers are reported to predict the efficacy of chemotherapy.The correlation of plasma D-dimer levels with tumor metastasis,staging,and chemotherapy efficacy has been analysed in many studies.This study aims to investgate the relationship between plasma D-dimer changes and tumor imaging changes in patients with advanced lung cancer.At the same time,to explore the correlation between plasma D-dimer and the efficacy of chemotherapy in advanced lung cancer.Materials and Methods:Retrospective analysis of patients diagnosed with pathology or cytology and between January 2013 and December 2017 were admitted to Jiangsu Provincial Tumor Hospital.Plasma D-dimer was measured within one week before chemotherapy in all patients,and at least one efficacy evaluation was performed.The curative effect evaluation was performed according to the internationally established solid tumor efficacy evaluation standard(RECIST)in 2000,and plasma D-dimer was reviewed within one week of the efficacy evaluation.D-dimer and serum tumor markers with two plasma D-dimer concentrations >0.55 mg/L at least once.The patient information was recorded and collected by the Jiangsu Provincial Cancer Hospital's Pre-information Electronic Case System and Ruimei Scientific Management System,including clinical features,pathological features,laboratory examination indicators,and CT(computed tomography)and MRI(magnetic resonance imaging,MRI).)Other radiological examination results.To investigate whether plasma D-dimer and lung cancer efficacy evaluation have some rules.Statistical analysis of experimental data was performed using the SPASS 19.0 statistical software package.The continuous variables were tested by the Mann-Whitney U test.The significance level of the statistical test was P=0.05.Results:(1)From January 2013 to December 2017,401 patients with advanced-stage lung cancer treated in Jiangsu Provincial Cancer Hospital Affiliated to Nanjing Medical University were recruited,among them 284 were male,117 were female,67 were in stage III,334 were stage IV.In addition,256 patients suffered from lung adenocarcinoma,65 squamous cell carcinoma,4 adenosquamous carcinoma,59 small cell carcinoma,4 poorly differentiated carcinoma,and 9 poorly differentiated carcinoma.Four hundred and one patients of the first plasma D-dimer Values(D1)ranged from 0.14-37.41 mg/L with a median of 1.26 mg/L.The second plasma D-dimer values before chemotherapy evaluation(D2)ranged from 0.17 to 35.81 mg/L,with a median of 1.40 mg/L.D1 and D2 were not statistically different in terms of gender and age.D1 and D2 were compared between pathological types by Mann-Whitney U test,in suggested squamous cell carcinoma vs adenocarcinoma,squamous cell carcinoma vs small cell carcinoma had a difference with statisticall significance(p <0.05).Values of D1 and D2 in adenocarcinoma group was higher than that of the squamous cell carcinoma group.Values of D1 and D2 in small cell carcinoma group was also higher than that of the squamous cell carcinoma group,suggesting that D1 and D2 are associated with pathological types of adenocarcinoma,squamous cell carcinoma,and small cell carcinoma.TNM staging application Mann-Whitney U test,suggesting that values of D1 and D2 in phase IV was higher than that of the phase III.(2)Plasma D-dimer levels was a statistically significant difference in the PR?SD and PD(p<0.05).The correlations between plasma D-dimer decrease amplitude ?D(D1-D2),plasma D-dimer decrease rate D-ratio(?D /D1)and short-term efficacy of chemotherapy(PR,SD,PD)were analyzed.The mean values of ?D and D-ratio in patients with clinical benefit(PR+SD)were higher than those with PD.Values of ?D and D-ratio measured by patients in the clinical benefit group(PR+SD)were significantly higher than those with PD(p<0.05).Conclusions:(1)This study suggests that plasma D-dimer is related to the stage and pathological type of patients with advanced lung cancer.Values of D1 and D2 in phase IV was higher than that of the phase III.The D-dimer level for patients with adenocarcinoma was significantly higher than for patients with the squamous cell and the small cell carcinoma.(2)This study demonstrated that the decline in plasma D-dimer levels was significantly associated with the efficacy of chemotherapy for patients with advanced lung cancer.Values of ?D and D-ratio measured by patients in the clinical benefit group(PR+SD)were significantly higher than those with PD(p<0.05). |
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