Clinicopathologic characteristics and prognosis of vascular cancer thrombus and D-dimer level in patient with gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HE Huan ,  LIU Zehan , LI Qilin

Department of General Surgery, The Third People’s Hospital of Chengdu City, Chengdu 610031, P. R. China;

Corresponding author：

LIU Zehan, Email: zehanliu92@163.com

Keywords：

gastric cancer; D-dimer; vascular cancer thrombus; prognosis

DOI：

10.7507/1007-9424.201904019

Video：

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Objective To analyze relationship between clinicopathologic features and prognosis of gastric cancer with or without vascular cancer thrombus and investigate clinical significances of plasma D-dimer in gastric cancer patient with vascular cancer thrombus.Method The clinicopathologic data of patients with gastric cancer who underwent the radical resection in The Third People’s Hospital of Chengdu City from January 2012 to December 2015 were analyzed. Results In this study, 295 patients with gastric cancer were enrolled, of which 250 without vascular cancer thrombus and 45 with vascular cancer thrombus. The results of multivariate analysis showed that the depth of invasion, lymph node metastasis, and D-dimer level were the independent influencing factors for the occurrence of vascular cancer thrombus in the patients with gastric cancer (P<0.050). The results of Cox multivariate analysis showed that the lymph node metastasis, high TNM stage, high D-dimer level, and presence of vascular cancer thrombus were the independent risk factors for the overall prognosis of patients with gastric cancer (P<0.050). The lymph node metastasis, high TNM stage, and high D-dimer level were the independent risk factors for the prognosis of gastric cancer patients with vascular cancer thrombus (P<0.050). The survival time of the gastric cancer patients with vascular cancer thrombus or with higher D-dimer level was significantly lower than that of the patients without vascular cancer thrombus or with lower D-dimer level (vascular cancer thrombus: 40.5 months versus 50.3 months, χ²=20.489, P=0.001; D-dimer level: 43.0 months versus 53.3 months, χ²=12.670, P<0.001).Conclusion Preoperative monitoring of D-dimer level has a certain reference value in evaluating formation of vascular cancer thrombus and judging prognosis in patient with gastric cancer.

Citation： HE Huan, LIU Zehan, LI Qilin. Clinicopathologic characteristics and prognosis of vascular cancer thrombus and D-dimer level in patient with gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(9): 1077-1082. doi: 10.7507/1007-9424.201904019 Copy

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2.	Ay C, Dunkler D, Pirker R, et al. High D-dimer levels are associated with poor prognosis in cancer patients. Haematologica, 2012, 97(8): 1158-1164.
3.	Park K, Ryoo BY, Ryu MH, et al. Incidence of venous throm-boembolism and the role of D-dimer as predictive marker in patients with advanced gastric cancer receiving chemotherapy: A prospective study. World J Gastrointest Oncol, 2017, 9(4): 176-183.
4.	高军, 李富良, 何旭. Ⅱ/Ⅲ型胃食管结合部腺癌淋巴结转移的影响因素及其对预后的影响. 中国普外基础与临床杂志, 2018, 25(11): 1327-1331.
5.	周魁平, 丁祥飞, 吴云阳, 等. 早期胃癌淋巴结转移与临床病理特征相关危险因素分析. 基因组学与应用生物学, 2018, 37(2): 618-623.
6.	张波, 令狐恩强, 柴宁莉, 等. 内镜黏膜下剥离术治疗早期胃癌中脉管癌栓相关因素分析. 临床军医杂志, 2018, 46(1): 34-36, 40.
7.	Sgourakis G, Gockel I, Lang H. Endoscopic and surgical resection of T1a/T1b esophageal neoplasms: a systematic review. World J Gastroenterol, 2013, 19(9): 1424-1437.
8.	朱信强, 张明, 丁闯, 等. 不同病理类型进展期胃癌的预后因素分析. 中国普外基础与临床杂志, 2017, 24(5): 580-586.
9.	Li P, He HQ, Zhu CM, et al. The prognostic significance of lymphovascular invasion in patients with resectable gastric cancer: a large retrospective study from Southern China. BMC Cancer, 2015, 15: 370.
10.	Matsumoto T, Kubota K, Aoki T, et al. Clinical impact of anatomical liver resection for hepatocellular carcinoma with pathologically proven portal vein invasion. World J Surg, 2016, 40(2): 402-411.
11.	Wang WL, Ye S, Yan S, et al. Pancreaticoduodenectomy with portal vein/superior mesenteric vein resection for patients with pancreatic cancer with venous invasion. Hepatobiliary Pancreat Dis Int, 2015, 14(4): 429-435.
12.	程树群, 孙居仙. 肝癌合并门静脉癌栓的诊治进展. 中国普外基础与临床杂志, 2019, 26(5): 513-518.
13.	Luo J, Yan Z, Liu Q, et al. Endovascular placement of iodine-125 seed strand and stent combined with chemoembolization for treatment of hepatocellular carcinoma with tumor thrombus in main portal vein. J Vasc Interv Radiol, 2011, 22(4): 479-489.
14.	Chen LW, Chien RN, Fang KM, et al. Elucidating therapeutic effects on patients with hepatocellular carcinoma and main portal vein thrombosis. Hepatogastroenterology, 2010, 57(98): 228-231.
15.	周俭, 肖永胜, 樊嘉. 肝癌合并门静脉癌栓的研究进展. 中国普外基础与临床杂志, 2012, 19(3): 243-246.
16.	Zhang QW, Zhang XT, Gao YJ, et al. Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review. J Dig Dis, 2019, 20(5): 223-228.
17.	Virgilio E, Balducci G, Mercantini P, et al. Laparoscopic intragastric surgery for treating early gastric cancer. Anticancer Res, 2018, 38(4): 1911-1916.
18.	Pyo JH, Lee H, Min BH, et al. Comparison of long-term outcomes after non-curative endoscopic resection in older patients with early gastric cancer. Ann Surg Oncol, 2017, 24(9): 2624-2631.
19.	Vogel SM, Smith LV, Peterson EJ. First-line therapies for vte treatment and secondary prophylaxis in patients with cancer: a new direction. J Pharm Pract, 2018 Dec 12: 897190018775580. doi: 10.1177/0897190018775580.
20.	López-Núñez JJ, Trujillo-Santos J, Monreal M. Management of venous thromboembolism in patients with cancer. J Thromb Haemost, 2018, 16(12): 2391-2396.
21.	Diao D, Cheng Y, Song Y, et al. D-dimer is an essential accompaniment of circulating tumor cells in gastric cancer. BMC Cancer, 2017, 17(1): 56.
22.	Diao D, Wang Z, Cheng Y, et al. D-dimer: not just an indicator of venous thrombosis but a predictor of asymptomatic hematogenous metastasis in gastric cancer patients. PLoS One, 2014, 9(7): e101125.
23.	马丽华, 钱屹崟, 吴剑平, 等. D-二聚体和肿瘤标记物在胃癌诊断中的价值. 江苏医药, 2014, 40(17): 2019-2021.
24.	杜彬, 陈强. 血浆D-二聚体水平与转移性胃癌临床特征及生存期相关分析. 福建医科大学, 2015: 52.
25.	Hakoum MB, Kahale LA, Tsolakian IG, et al. Anticoagulation for the initial treatment of venous thromboembolism in people with cancer. Cochrane Database Syst Rev, 2018, 1: CD006649.
26.	Kuderer NM, Khorana AA, Lyman GH, et al. A meta-analysis and systematic review of the efficacy and safety of anticoagulants as cancer treatment: impact on survival and bleeding complications. Cancer, 2007, 110(5): 1149-1161.
27.	Yu J, Li D, Lei D, et al. Tumor-specific D-dimer concentration ranges and influencing factors: a cross-sectional study. PLoS One, 2016, 11(11): e0165390.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. Ay C, Dunkler D, Pirker R, et al. High D-dimer levels are associated with poor prognosis in cancer patients. Haematologica, 2012, 97(8): 1158-1164.
3. Park K, Ryoo BY, Ryu MH, et al. Incidence of venous throm-boembolism and the role of D-dimer as predictive marker in patients with advanced gastric cancer receiving chemotherapy: A prospective study. World J Gastrointest Oncol, 2017, 9(4): 176-183.
4. 高军, 李富良, 何旭. Ⅱ/Ⅲ型胃食管结合部腺癌淋巴结转移的影响因素及其对预后的影响. 中国普外基础与临床杂志, 2018, 25(11): 1327-1331.
5. 周魁平, 丁祥飞, 吴云阳, 等. 早期胃癌淋巴结转移与临床病理特征相关危险因素分析. 基因组学与应用生物学, 2018, 37(2): 618-623.
6. 张波, 令狐恩强, 柴宁莉, 等. 内镜黏膜下剥离术治疗早期胃癌中脉管癌栓相关因素分析. 临床军医杂志, 2018, 46(1): 34-36, 40.
7. Sgourakis G, Gockel I, Lang H. Endoscopic and surgical resection of T1a/T1b esophageal neoplasms: a systematic review. World J Gastroenterol, 2013, 19(9): 1424-1437.
8. 朱信强, 张明, 丁闯, 等. 不同病理类型进展期胃癌的预后因素分析. 中国普外基础与临床杂志, 2017, 24(5): 580-586.
9. Li P, He HQ, Zhu CM, et al. The prognostic significance of lymphovascular invasion in patients with resectable gastric cancer: a large retrospective study from Southern China. BMC Cancer, 2015, 15: 370.
10. Matsumoto T, Kubota K, Aoki T, et al. Clinical impact of anatomical liver resection for hepatocellular carcinoma with pathologically proven portal vein invasion. World J Surg, 2016, 40(2): 402-411.
11. Wang WL, Ye S, Yan S, et al. Pancreaticoduodenectomy with portal vein/superior mesenteric vein resection for patients with pancreatic cancer with venous invasion. Hepatobiliary Pancreat Dis Int, 2015, 14(4): 429-435.
12. 程树群, 孙居仙. 肝癌合并门静脉癌栓的诊治进展. 中国普外基础与临床杂志, 2019, 26(5): 513-518.
13. Luo J, Yan Z, Liu Q, et al. Endovascular placement of iodine-125 seed strand and stent combined with chemoembolization for treatment of hepatocellular carcinoma with tumor thrombus in main portal vein. J Vasc Interv Radiol, 2011, 22(4): 479-489.
14. Chen LW, Chien RN, Fang KM, et al. Elucidating therapeutic effects on patients with hepatocellular carcinoma and main portal vein thrombosis. Hepatogastroenterology, 2010, 57(98): 228-231.
15. 周俭, 肖永胜, 樊嘉. 肝癌合并门静脉癌栓的研究进展. 中国普外基础与临床杂志, 2012, 19(3): 243-246.
16. Zhang QW, Zhang XT, Gao YJ, et al. Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review. J Dig Dis, 2019, 20(5): 223-228.
17. Virgilio E, Balducci G, Mercantini P, et al. Laparoscopic intragastric surgery for treating early gastric cancer. Anticancer Res, 2018, 38(4): 1911-1916.
18. Pyo JH, Lee H, Min BH, et al. Comparison of long-term outcomes after non-curative endoscopic resection in older patients with early gastric cancer. Ann Surg Oncol, 2017, 24(9): 2624-2631.
19. Vogel SM, Smith LV, Peterson EJ. First-line therapies for vte treatment and secondary prophylaxis in patients with cancer: a new direction. J Pharm Pract, 2018 Dec 12: 897190018775580. doi: 10.1177/0897190018775580.
20. López-Núñez JJ, Trujillo-Santos J, Monreal M. Management of venous thromboembolism in patients with cancer. J Thromb Haemost, 2018, 16(12): 2391-2396.
21. Diao D, Cheng Y, Song Y, et al. D-dimer is an essential accompaniment of circulating tumor cells in gastric cancer. BMC Cancer, 2017, 17(1): 56.
22. Diao D, Wang Z, Cheng Y, et al. D-dimer: not just an indicator of venous thrombosis but a predictor of asymptomatic hematogenous metastasis in gastric cancer patients. PLoS One, 2014, 9(7): e101125.
23. 马丽华, 钱屹崟, 吴剑平, 等. D-二聚体和肿瘤标记物在胃癌诊断中的价值. 江苏医药, 2014, 40(17): 2019-2021.
24. 杜彬, 陈强. 血浆D-二聚体水平与转移性胃癌临床特征及生存期相关分析. 福建医科大学, 2015: 52.
25. Hakoum MB, Kahale LA, Tsolakian IG, et al. Anticoagulation for the initial treatment of venous thromboembolism in people with cancer. Cochrane Database Syst Rev, 2018, 1: CD006649.
26. Kuderer NM, Khorana AA, Lyman GH, et al. A meta-analysis and systematic review of the efficacy and safety of anticoagulants as cancer treatment: impact on survival and bleeding complications. Cancer, 2007, 110(5): 1149-1161.
27. Yu J, Li D, Lei D, et al. Tumor-specific D-dimer concentration ranges and influencing factors: a cross-sectional study. PLoS One, 2016, 11(11): e0165390.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinicopathologic characteristics and prognosis of vascular cancer thrombus and D-dimer level in patient with gastric cancer

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