结直肠癌患者预后不良的预测：术前凝血酶原时间 (PT) 和活化部分凝血活酶时间 (APTT) 升高。,Cancer Management and Research

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结直肠癌患者预后不良的预测：术前凝血酶原时间 (PT) 和活化部分凝血活酶时间 (APTT) 升高。
Cancer Management and Research ( IF 2.5 ) Pub Date : 2020-07-03 , DOI: 10.2147/cmar.s246695
Lin Zhang _{1,

2} , Juan Ye _{2,

3,

4} , Qiuyun Luo ₂ , Miaohuan Kuang ₁ , Minjie Mao ₁ , Shuqin Dai ₁ , Xueping Wang ₁

Affiliation

背景与目的：无创评估结直肠癌（CRC）预后的工具具有深远的意义。尽管已在多种肿瘤中研究了血浆凝血试验，但尚未讨论 CRC 中凝血酶原时间 (PT) 和活化部分促凝血酶原激酶时间 (APTT) 的预后价值。我们的研究目的是探讨术前 PT 和 APTT 在 CRC 患者中的预后意义。
患者与方法：回顾性分析250例CRC患者术前凝血指标PT、PTA、INR、APTT、FIB、TT、PLT、NLR、PLR。Kaplan-Meier 和多变量 Cox 回归分析用于证明这些术前凝血指标的预后价值。
结果：PT和APTT水平较低的CRC患者的总生存期（OS，p < 0.05）和无病生存期（DFS，p < 0.05）显着延长。基于单变量分析，PT 水平 ( p < 0.001, p < 0.001), PTA 水平 ( p =0.001, p =0.001), APTT 水平 ( p =0.001, p < 0.001), INR 水平 ( p < 0.001, p < 0.001)、纤维蛋白原水平 ( p =0.032, p =0.036)、肿瘤状态 ( p =0.005, p =0.003)、淋巴结状态 ( p < 0.001, p< 0.001)、转移状态 ( p < 0.001, p < 0.001) 和 TNM 分期 ( p < 0.001, p < 0.001) 与 DFS 和 OS 显着相关。多变量 Cox 回归分析表明，PT（HR：2.699，p = 0.006）和 APTT（HR：1.942，p = 0.015）、转移状态（HR：2.091，p = 0.015）和 TNM 分期（HR：7.086，p= 0.006) 是 CRC 生存的独立预测因子。在整个队列中，将入组患者根据其PT和APTT水平分为三组。OS和DFS在低风险（PT<11.85秒和APTT<25.85秒）、中风险（PT≥11.85秒或APTT≥25.85秒）和高风险（PT≥11.85秒和APTT≥ 25.85 秒）组。
结论：术前 PT 和 APTT 水平升高是 CRC 患者预后不良的预测因素。此外，术前 PT 和 APTT 的结合可以成为一种新的预后分层方法，用于更精确的 CRC 临床分期。

关键词： PT，APTT，CRC，预后

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Prediction of Poor Outcomes in Patients with Colorectal Cancer: Elevated Preoperative Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT).

Background and Objective: Tools for the non-invasive assessment of colorectal cancer (CRC) prognosis have profound significance. Although plasma coagulation tests have been investigated in a variety of tumours, the prognostic value of the prothrombin time (PT) and activated partial thromboplastin time (APTT) in CRC has not been discussed. Our study objective was to explore the prognostic significance of preoperative PT and APTT in CRC patients.
Patients and Methods: A retrospective analysis of preoperative coagulation indexes including PT, PTA, INR, APTT, FIB, TT, PLT, NLR and PLR in 250 patients with CRC was performed. Kaplan–Meier and multivariate Cox regression analysis were used to demonstrate the prognostic value of these preoperative coagulation indexes.
Results: The overall survival (OS, p< 0.05) and disease-free survival (DFS, p< 0.05) of CRC patients with lower PT and APTT levels were significantly prolonged. Based on univariate analysis, PT levels (p< 0.001, p< 0.001), PTA levels (p=0.001, p=0.001), APTT levels (p=0.001, p< 0.001), INR levels (p< 0.001, p< 0.001), fibrinogen levels (p=0.032, p=0.036), tumour status (p=0.005, p=0.003), nodal status (p< 0.001, p< 0.001), metastasis status (p< 0.001, p< 0.001) and TNM stages (p< 0.001, p< 0.001) were remarkably associated with DFS and OS. Multivariate Cox regression analysis suggested that the levels of PT (HR: 2.699, p=0.006) and APTT (HR: 1.942, p=0.015), metastasis status (HR: 2.091, p= 0.015) and TNM stage (HR: 7.086, p=0.006) were independent predictors of survival in CRC. In the whole cohort, the enrolled patients were then divided into three groups according to their PT and APTT levels. The OS and DFS differed notably among the low-risk (PT< 11.85 sec and APTT< 25.85 sec), medium-risk (PT≥ 11.85 sec or APTT≥ 25.85 sec), and high-risk (PT≥ 11.85 sec and APTT≥ 25.85 sec) groups.
Conclusion: Elevated levels of preoperative PT and APTT were predictors of poor outcomes in CRC patients. Moreover, the combination of preoperative PT and APTT can be a new prognostic stratification approach for more precise clinical staging of CRC.

Keywords: PT, APTT, CRC, prognosis

更新日期：2020-07-03

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