Usefulness of plasma D-dimer level for monitoring development of distant organ metastasis in colorectal cancer patients after curative resection.
Usefulness of plasma D-dimer level for monitoring development of distant organ metastasis in colorectal cancer patients after curative resection.
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DOI：
10.2147/cmar.s177274
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发表时间：
2018
影响因子：
3.3
通讯作者：
Cui W
中科院分区：
文献类型：
--
作者：
Guo Y;Chen F;Cui W
目的探讨血浆D-二聚体水平在监测结直肠癌（CRC）患者术后远处器官转移中的作用。178例根治性切除后的CRC患者入组研究。92例患者在随访期间发生了远处器官转移（异时性转移），并在确认转移的当天采集血液。86例患者尚未出现转移的证据，并在末次回访时对他们的血液样本进行了评价。比较两组患者的D-二聚体、癌胚抗原（CEA）和乳酸脱氢酶（LDH）水平。检测D-二聚体与癌胚抗原（CEA）或乳酸脱氢酶（LDH）的一致性。应用受试者工作特征曲线（ROC）评价D-二聚体、癌胚抗原（CEA）、乳酸脱氢酶（LDH）及其联合检测对远处器官转移的诊断价值。结直肠癌异时转移组D-二聚体水平明显高于无转移组（P<0.0001）。D-二聚体与CEA的一致性较好（κ=0.416，P<0.0001）。与CEA（0.72）或LDH（0.68）相比，D-二聚体具有更大的ROC下面积（AUC）（0.85）。D-二聚体检测的特异性（73.3%）低于CEA（74.4%），但敏感性（88.0%）高于CEA（65.2%），差异有显著性（上级）。LDH的敏感性最低（42.4%），特异性最高（95.3%）。联合检测（D-二聚体升高或CEA升高）的敏感性和阴性预测值（NPV）分别为94.6%和91.1%，另一联合检测（D-二聚体升高和LDH升高）的特异性和阳性预测值分别为97.7%和94.9%。三种标记物的平行试验使敏感性和NPV分别提高到95.7%和92.7%。D-二聚体与癌胚抗原和/或乳酸脱氢酶联合检测可作为大肠癌根治术后远处器官转移的监测指标。
To investigate the usefulness of plasma D-dimer level for monitoring the development of distant organ metastasis in colorectal cancer (CRC) patients after curative resection. One hundred and seventy-eight CRC patients after curative resection were enrolled in the study. Ninety-two patients developed distant organ metastasis during follow-up (metachronous metastasis), and blood was collected on the day metastasis was confirmed. Eighty-six patients had no evidence of metastasis yet, and their blood samples were evaluated at last return visit. The levels of D-dimer, carcinoembryonic antigen (CEA), and lactate dehydrogenase (LDH) between two patient groups were compared. The agreement between D-dimer and CEA (or LDH) was examined. The receiver operator characteristic (ROC) curve was used to evaluate the performance of D-dimer, CEA, LDH, and their combination in detection of distant organ metastasis. The level of D-dimer in CRC patients with metachronous metastasis was higher than that in non-metastasis patients (P<0.0001). Agreement between D-dimer and CEA was fair (κ=0.416, P<0.0001). D-dimer had a larger area under ROC (AUC) (0.85) compared to CEA (0.72) or LDH (0.68). The specificity of D-dimer (73.3%) was lower than that of CEA (74.4%), but the sensitivity (88.0%) of D-dimer assay was superior to that of CEA assay (65.2%). LDH showed the lowest sensitivity (42.4%) and highest specificity (95.3%) among the three bio-markers. The sensitivity and negative predictive value (NPV) of a combination assay (either D-dimer elevation or CEA elevation) were 94.6% and 91.1%, respectively, and the specificity and positive predictive value of another combination assay (both D-dimer elevation and LDH elevation) were 97.7% and 94.9%, respectively. Parallel test of the three markers improved the sensitivity and NPV to 95.7% and 92.7%, respectively. Combining with CEA and/or LDH, D-dimer could be a useful surveillance marker for distant organ metastasis in CRC patients after curative resection.