| Background: Since Professor Trousseau proposed the correlation between malignant tumors and thrombosis after related studies in the 19 th century,the relationship between malignant tumors and thrombosis has become a hot spot for scholars at home and abroad.Many scholars pointed out that it is very common for malignant tumors to have a hypercoagulable state after research.Compared with non-tumor patients,patients with malignant tumors be at a significantly higher risk of secondary thromboembolism duing to the hypercoagulable state,and the mortality rate is also significantly higher,which is seriously affect the prognosis of patients.In recent years,the incidence of gastrointestinal malignant tumors is increasing year by year,and among all types of malignant tumors,gastrointestinal malignant tumors are one of the malignant tumors with the highest incidence of venous thrombosis.Thrombosis brings great challenges to the diagnosis and treatment and prognosis of gastrointestinal malignant tumors.Biological characteristics such as gender,age,tumor stage,degree of differentiation,and treatment measures such as surgery and chemotherapy may be related to the patient’s hypercoagulable state for gastrointestinal malignant tumors.However,different biological characteristics or different treatment measures have different effects on the coagulation function of patients with malignant tumors.Whether it aggravates the risk of thrombosis or reduces the risk of thrombosis is still inconclusive.The hypercoagulable state before thrombosis lack of obvious and specific clinical manifestations or symptoms and signs,and diagnostic measures such as ultrasound and imaging also cannot accurately check the hypercoagulable state.At present,most scholars believe that laboratory testing of coagulation related parameters can determine the patient’s hypercoagulable state earlier than ultrasound and imaging examinations,so as to prevent and monitor malignant tumor thrombosis in advance.However,various research conclusions of the diagnostic significance of coagulation related parameters which routinely carried out in clinics for the hypercoagulable state in patients with malignant tumors are different.So far,no specific and sensitive parameters have been found to effectively monitor thrombosis in patients with malignant tumors.Therefore,clarifying the influencing factors of the hypercoagulable state in patients with gastrointestinal malignant tumors and discovering the coagulation related parameters which are valuable for judging the hypercoagulable state of patients can effectively prevent thrombosis and improve the prognostic value of patients with gastrointestinal malignant tumors,which has a very important meaning.Objectives: To explore the coagulation function status of patients with gastrointestinal malignant tumors and the effects of biological characteristics and the treatment measures such as surgery and chemotherapy on the coagulation function and hypercoagulable state of patients,and to explore valuable coagulation related parameters for judging the hypercoagulable state of patients with gastrointestinal malignant tumors,and to provide a theoretical basis for clinical prevention and diagnosis of gastrointestinal malignant tumors complicated by thromboembolism,so as to improve the treatment effect of patients and improve the prognosis of patients.Methods: This study conducted a retrospective study of the relationship between gastrointestinal malignant tumors and hypercoagulable state by collecting relevant data.1562 patients with gastrointestinal malignant tumors(553 cases of gastric cancer,496 cases of colon cancer,513 cases of rectal cancer)who were first admitted to the hospital from September 2017 to December 2019 in the Guangxi Medical University Cancer Hospital and did not receive relevant treatments were taken as the research object,and the included research subjects are all diagnosed as gastrointestinal malignant tumors by cytology,imaging,pathology,etc.Divided into gastric cancer group,colon cancer group and rectal cancer group according to the types of gastrointestinal malignant tumors.Collect the clinical data of patients of each group such as gender,age,clinical stage,degree of differentiation,and the results of coagulation related parameters [Platelets(PLT),Antithrombin Ⅲ activity(AT-Ⅲ%),D-dimer(DD),Prothrombin time(PT),Thrombin time(TT),Activation partial thromboplastin time(APTT),Fibrinogen(FIB)] on admission without surgery,chemotherapy and other anti-tumor treatments.In addition,the results of coagulation related parameters before and after surgery and chemotherapy were collected(In order to avoid interference between treatment measures,only the results of coagulation related parameters before and after a single treatment measure are adopted).In the same period,304 healthy people who underwent physical examinations in the Guangxi Medical University Cancer Hospital were used as the control group for this study,and the control group’s basic data such as gender and age and the results of coagulation related parameters were collected.Perform statistical analysis on the data.First,comparing the difference of the abnormal rate and the detection value of coagulation related parameters between each group,and analyzing the coagulation function status of gastrointestinal malignant tumors before receiving anti-tumor-related treatments and the correlation between coagulation related parameters and hypercoagulable state.Secondly,comparing the differences in coagulation related parameters under different biological characteristics of each group,and analyzing the correlation between the biological characteristics of gastrointestinal malignant tumors and the hypercoagulable state.Finally,comparing the changes of coagulation related parameters before and after surgery and chemotherapy,and analyzing the correlation between treatment measures such as surgery and chemotherapy and the hypercoagulable state of patients with gastrointestinal malignant tumors.Results:1.General situation of coagulation related parameters in gastrointestinal malignant tumorsThe abnormal rate of coagulation related parameters in patients with gastric cancer,colon cancer,and rectal cancer were higher than that in the control group,which mainly reflected in the increase of the abnormal rates of PLT,PT,FIB,AT-Ⅲ%,and DD.Comparing the three types of gastrointestinal malignant tumors,the highest abnormal rate of coagulation related parameters was in the colon cancer,followed by the gastric cancer,and the lowest in the rectal cancer.The differences in the detection results of coagulation related parameters between the patients with gastric cancer,colon cancer,rectal cancer and the control group are mainly reflected in the increase of the results of PLT,FIB,DD and the decrease of the results of AT-Ⅲ%.Comparing the three types of gastrointestinal malignant tumors,the patients with colon cancer had the most abnormal results.2.The results of coagulation related parameters under different biological characteristics of gastrointestinal malignant tumorsGender: The results of APTT and FIB of women with gastric cancer were lower than men;The results of PLT of women with colon cancer were higher than men,and the results of FIB of women were lower than men in the colon cancer group;There was no significant difference in coagulation related parameters of different genders in the rectal cancer.Ages: The results of FIB and DD in the patients with gastric cancer increased with the increase of age,and the results of AT-Ⅲ% decrease with the increase of age,and the difference is significant in the >60 years old group.The results of DD in >60 years old group in the patients with colon cancer were significantly higher than those in the 45～60 years old group and <45 years old group;The results of AT-Ⅲ% in the >60 years old group were significantly lower than those in the 45-60 years old group and <45 years old group;There is little difference in coagulation related parameters between the 45-60 years old group and the <45 years old group.The results of FIB and DD in the patients with rectal cancer increased with the increase of age,and the results of AT-Ⅲ%decreased with the increase of age,and the difference was most obvious between the >60 years old group and the <45 years old group.Stages: The results of PLT,FIB,DD in the patients with gastric cancer and rectal cancer increased with the increase of stage.The results of PLT,FIB,and DD increased with the increase of the stage in the patients with colon cancer,and the results of AT-Ⅲ% decreased with the increase of the stage.Differentiation: The results of PLT of the patients with moderately and poorly differentiated in the gastric cancer are obviously higher than those of the patients with high differentiated;The results of DD of the patients with poorly differentiated were higher than that of the patients with high and moderately differentiated.The results of PLT,FIB,and DD in the patients with colon cancer and rectal cancer increased as the degree of differentiation decreased,and the difference was most obvious between poorly differentiated and high differentiated.3.The results of coagulation related parameters before and after surgery in gastrointestinal malignant tumorsThe results of PLT,AT-Ⅲ% decreased and the results of PT,APTT,FIB,DD increased after surgery in the patients with gastric cancer and rectal cancer.The results of PLT,AT-Ⅲ% decreased and the results of PT,APTT,DD increased after surgery in the patients with colon cancer.4.The results of coagulation related parameters before and after chemotherapy in gastrointestinal malignant tumorsOnly the results of PLT reduced after chemotherapy in the patients with gastric cancer.The results of PLT decreased and the results of DD increased after chemotherapy in the patients with colon cancer and rectal cancer.Conclusions:1.The patients with gastrointestinal malignant tumors are more likely to have coagulation dysfunction than normal people,and the abnormal coagulation function is mainly in the state of blood hypercoagulability.PLT,FIB,DD,AT-Ⅲ% can be used to judge and monitor the hypercoagulable state in clinical practice.2.The patients with gastrointestinal malignant tumors with the older of age,the later of stage,and the lower of degree of differentiation,the more severe of hypercoagulable state will be.We should focus on the prevention and monitoring of thrombosis in elderly,late,and poorly differentiated patients in clinical practice.There is no exact relationship between the hypercoagulable state and the gender of patients.3.Hypercoagulable state and bleeding risk coexist after surgery in gastrointestinal malignant tumors.While preventing postoperative bleeding in patients,FIB,AT-Ⅲ% and DD should also be used to prevent and monitor postoperative hypercoagulable state and thrombosis.Chemotherapy has no definite effect on the hypercoagulable state. |
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