结直肠癌(CRC),最常见的癌症之一,伴随着血栓性并发症的发生率非常高。本研究旨在阐明KRAS突变与可手术CRC高凝状态之间的关系。还研究了术前D-二聚体水平的预后价值,从而为提高患者生存率和降低发病率的治疗策略的发展提供了新的见解。因此,昆明医科大学附属延安医院333例CRC术后病例的前瞻性分析,在2019年5月至2022年10月期间进行。人口统计数据,肿瘤特征和D-二聚体水平从电子健康档案中收集.静脉血栓栓塞(VTE)通过多普勒或计算机断层扫描血管造影诊断,D-二聚体阈值设置为550和1,650µg/l。在56例病例的子集中评估了密码子12和13处的KRAS突变。随后,前瞻性分析影响这些患者高凝状态的因素,关注KRAS的关键作用。结果显示,KRAS基因突变与术前D-二聚体水平升高有关,在野生型队列中,1,076微克/升与485微克/升相比,指示高凝状态。D-二聚体水平升高也与血管浸润有关,远处转移和术后VTE风险增加。此外,多变量分析确定了KRAS突变,远处转移和血管浸润是D-二聚体水平升高的独立预测因子,相对风险值分别为2.912、1.884和1.525。相反,性别,年龄,肿瘤位置,分化等级,Ki67指数和肿瘤分期对D-二聚体水平无显著影响,因此表明CRC中肿瘤遗传学和凝血功能障碍之间复杂的相互作用。目前的研究表明,KRAS突变状态,远处转移和血管侵犯可被认为是CRC患者血液高凝状态的独立危险因素,潜在的VTE风险预后因素。
Colorectal cancer (CRC), one of the most prevalent types of cancer, is accompanied by a notably high incidence of thrombotic complications. The present study aimed to elucidate the association between KRAS mutations and hypercoagulability in operable CRC. The prognostic value of preoperative D-dimer levels was also investigated, thus providing novel insights into the development of therapeutic strategies to enhance patient survival and diminish morbidity. Therefore, a prospective analysis of 333 CRC cases post-surgery at Yan\'an Hospital Affiliated to Kunming Medical University, between May 2019 and October 2022 was performed. Data on demographics, tumor characteristics and D-dimer levels were compiled from the electronic health records. Venous thromboembolism (VTE) was diagnosed by doppler or computed tomography angiography, with D-dimer thresholds set at 550 and 1,650 µg/l. KRAS mutations at codons 12 and 13 were assessed in a subset of 56 cases. Subsequently, the factors affecting the hypercoagulable state in these patients were prospectively analyzed, focusing on the pivotal role of KRAS. The results showed that KRAS mutations were associated with elevated preoperative D-dimer levels, with 1,076 µg/l compared with 485 µg/l in the wild-type cohort, indicative of a hypercoagulable state. Increased D-dimer levels were also associated with vascular invasion, distant metastases and a heightened risk of postoperative VTE. Furthermore, multivariate analyses identified KRAS mutations, distant metastases and vascular invasion as independent predictors of elevated D-dimer levels, with relative risk values of 2.912, 1.884 and 1.525, respectively. Conversely, sex, age, tumor location, differentiation grade, Ki67 index and tumor stage could not significantly affect D-dimer levels, thus indicating a complex interplay between tumor genetics and coagulation dysfunction in CRC. The current study suggested that the KRAS mutation status, distant metastasis and vascular invasion could be considered as independent risk factors of blood hypercoagulability in patients with CRC, potentially serving as prognostic factors for VTE risk.