背景:近年来,据报道,常规凝血(CC)和血栓弹力图(TEG)参数与胰腺癌(PC)的进展密切相关。然而,这些参数在区分良性和恶性胰腺疾病中的潜在效用仍不清楚。
目的:进行了一项回顾性研究,以评估凝血参数在区分胰腺癌/早期胰腺癌(EPC,TNM阶段I和II)来自良性控制条件,并进一步探讨凝血指标是否能提高CA199的差值。
方法:使用受试者工作特征(ROC)曲线和逻辑回归分析来确定每个凝血参数或参数组合的诊断价值。
结果:与良性胰腺疾病(BPD)相比,胰腺恶性肿瘤患者有明显的凝血功能紊乱,具体表现为几个CC和TEG参数的异常增加或减少(例如活化部分凝血活酶时间(APTT),纤维蛋白原(FIB),D-二聚体(DD2),K时间,R时间,角材,最大振幅(MA),凝血指数(CI),和Ly30)。在训练组中,ROC曲线显示FIB,DD2,角度,MA,和CI在区分PC或EPC与BPD方面具有良好的疗效(对于PC,AUC=0.737、0.654、0.627、0.602、0.648;对于EPC,AUC=0.723、0.635、0.630、0.614、0.648)。然而,基于FIB的几个组合诊断指标,DD2和CI在诊断效率方面未能优于单个凝血指标。在识别PC或EPC时,某些凝血指标与CA199的组合优于单独的CA199,尤其是FIB+CA199(对于PC,AUC=0.904;对于EPC,AUC=0.905),FIB+DD2+CA199(对于PC,AUC=0.902;对于EPC,AUC=0.900),FIB+CI+CA199(对于PC,AUC=0.906;对于EPC,AUC=0.906),和FIB+DD2+CI+CA199(对于PC,AUC=0.905;对于EPC,AUC=0.900)。来自验证集的结果还证实,这些组合对于PC和EPC具有有利的诊断价值。
结论:PC中普遍存在明显的高凝状态。一些CC和TEG参数对良恶性胰腺疾病的鉴别诊断有价值。此外,凝血指标联合CA199可进一步提高CA199在PC和EPC中的鉴别诊断效能。
BACKGROUND: In recent years, conventional coagulation (CC) and thromboelastography (TEG) parameters have been reported to be closely related to the progression of pancreatic cancer (PC). However, the potential utility of these parameters in differentiating benign and malignant pancreatic diseases is still unclear.
OBJECTIVE: A retrospective study was conducted to evaluate the efficacy of coagulation parameters in differentiating pancreatic cancer/early stage pancreatic cancer (EPC, TNM stages I and II) from benign control conditions, and to further explore whether coagulation parameters could improve the differential value of CA199.
METHODS: Receiver operating characteristic (ROC) curves and logistic regression analysis were used to identify the diagnostic value of each coagulation parameter or combination of parameters.
RESULTS: Compared with benign pancreatic disease (BPD), patients with pancreatic malignant tumors had significant coagulation disorders, specifically manifested as abnormal increases or decreases in several CC and TEG parameters (such as activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer (DD2), K time, R time, Angle, maximum amplitude (MA), coagulation index (CI), and Ly30). In the training group, ROC curve showed that FIB, DD2, Angle, MA, and CI had favorable efficacy at differentiating PC or EPC from BPD (for PC, AUC = 0.737, 0.654, 0.627, 0.602, 0.648; for EPC, AUC = 0.723, 0.635, 0.630, 0.614, 0.648). However, several combined diagnostic indicators based on FIB, DD2 and CI failed to outperform the individual coagulation indexes in diagnostic efficiency. Combinations of certain coagulation indexes with CA199 outperformed CA199 alone at identifying PC or EPC, especially FIB + CA199 (for PC, AUC = 0.904; for EPC, AUC = 0.905), FIB + DD2 + CA199 (for PC, AUC = 0.902; for EPC, AUC = 0.900), FIB + CI + CA199 (for PC, AUC = 0.906; for EPC, AUC = 0.906), and FIB + DD2 + CI + CA199 (for PC, AUC = 0.905; for EPC, AUC = 0.900). The results from a validation set also confirmed that these combinations have advantageous diagnostic value for PC and EPC.
CONCLUSIONS: A significant hypercoagulable state was common in PC. Some CC and TEG parameters are valuable in the differential diagnosis of benign and malignant pancreatic diseases. In addition, coagulation indexes combined with CA199 can further enhance the differential diagnosis efficacy of CA199 in PC and EPC.