D-Dimer and Prothrombin Fragment 1+2 Predict Venous Thromboembolism in Patients With Cancer: Results From the Vienna Cancer and Thrombosis Study
D-Dimer and Prothrombin Fragment 1+2 Predict Venous Thromboembolism in Patients With Cancer: Results From the Vienna Cancer and Thrombosis Study
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DOI：
10.1200/jco.2008.21.7752
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发表时间：
2009-09-01
影响因子：
45.3
通讯作者：
Pabinger, Ingrid
中科院分区：
文献类型：
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作者：
Ay, Cihan;Vormittag, Rainer;Pabinger, Ingrid
静脉血栓栓塞症(VTE)是公认的癌症并发症。实验室参数可能有助于评估癌症患者的静脉血栓栓塞症风险。本研究的目的是研究反映凝血和纤溶激活的D-二聚体和凝血酶原片段1+2(F1+2)在预测癌症相关性VTE中的作用。患者和方法在821例最近未接受化疗、放疗或手术的新诊断癌症或疾病进展的患者中进行前瞻性、观察性队列研究，并进行中位时间501天(四分位数范围255至731天)的随访。其中乳腺癌132例，肺癌119例，胃35例，下胃肠道106例，胰腺46例，肾22例，前列腺癌101例，高度恶性胶质瘤102例，恶性淋巴瘤94例，多发性骨髓瘤17例，其他肿瘤47例。研究终点为客观确诊的症状性或致死性VTE的发生。D-二聚体升高和F1+2升高的临界值设定在总研究人群的第75个百分位数。在包括D-二聚体升高、F1+2升高、年龄、性别、手术、化疗和放疗在内的多变量分析中，D-二聚体升高(HR，1.8；95%CI，1.0~3.2；P=.048)和F1+2升高(HR，2.0；95%CI，1.2~3.6；P=.015)患者发生VTE的风险比(HR)显著增加。D-二聚体升高和F1+2同时升高的患者6个月后发生VTE的累积概率(15.2%)高于非D-二聚体和非升高F1+2患者(5.0%；P<0.01)。结论高D-二聚体和F1+2水平独立预测癌症患者VTE的发生。
PurposeVenous thromboembolism (VTE) is a well-recognized complication of cancer. Laboratory parameters might be useful to assess the VTE risk in patients with cancer. The aim of this study was to investigate D-dimer and prothrombin fragment 1 + 2 (F 1 + 2), which reflect activation of blood coagulation and fibrinolysis, for prediction of cancer-associated VTE.Patients and MethodsIn a prospective, observational, cohort study of 821 patients with newly diagnosed cancer or progression of disease who did not recently receive chemotherapy, radiotherapy, or surgery were enrolled and followed for a median of 501 days (interquartile range, 255 to 731 days). The malignancies in these patients were as follows: breast (n = 132), lung (n = 119), stomach (n = 35), lower gastrointestinal tract (n = 106), pancreas (n = 46), kidney (n = 22), and prostate (n = 101) cancers; high-grade glioma (n = 102); malignant lymphoma (n = 94); multiple myeloma (n = 17); and other tumor types (n = 47). The study end point was occurrence of objectively confirmed symptomatic or fatal VTE.ResultsVTE occurred in 62 patients (7.6%). The cutoff level for elevated D-dimer and elevated F 1 + 2 was set at the 75th percentile of the total study population. In multivariable analysis that included elevated D-dimer, elevated F 1 + 2, age, sex, surgery, chemotherapy, and radiotherapy, the hazard ratios (HRs) of VTE in patients with elevated D-dimer (HR, 1.8; 95% CI, 1.0 to 3.2; P = .048) and elevated F 1 + 2 (HR, 2.0; 95% CI, 1.2 to 3.6; P = .015) were statistically significantly increased. The cumulative probability of developing VTE after 6 months was highest in patients with both elevated D-dimer and elevated F 1 + 2 (15.2%) compared with patients with nonelevated D-dimer and nonelevated F 1 + 2 (5.0%; P < .001).ConclusionHigh D-dimer and F 1 + 2 levels independently predict occurrence of VTE in patients with cancer.