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

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.	高軍, 李富良, 何旭. Ⅱ/Ⅲ型胃食管結合部腺癌淋巴結轉移的影響因素及其對預后的影響. 中國普外基礎與臨床雜志, 2018, 25(11): 1327-1331.
5.	周魁平, 丁祥飛, 吳云陽, 等. 早期胃癌淋巴結轉移與臨床病理特征相關危險因素分析. 基因組學與應用生物學, 2018, 37(2): 618-623.
6.	張波, 令狐恩強, 柴寧莉, 等. 內鏡黏膜下剝離術治療早期胃癌中脈管癌栓相關因素分析. 臨床軍醫雜志, 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.	朱信強, 張明, 丁闖, 等. 不同病理類型進展期胃癌的預后因素分析. 中國普外基礎與臨床雜志, 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.	程樹群, 孫居仙. 肝癌合并門靜脈癌栓的診治進展. 中國普外基礎與臨床雜志, 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.	周儉, 肖永勝, 樊嘉. 肝癌合并門靜脈癌栓的研究進展. 中國普外基礎與臨床雜志, 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-Nú?ez 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.	馬麗華, 錢屹崟, 吳劍平, 等. D-二聚體和腫瘤標記物在胃癌診斷中的價值. 江蘇醫藥, 2014, 40(17): 2019-2021.
24.	杜彬, 陳強. 血漿D-二聚體水平與轉移性胃癌臨床特征及生存期相關分析. 福建醫科大學, 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. 高軍, 李富良, 何旭. Ⅱ/Ⅲ型胃食管結合部腺癌淋巴結轉移的影響因素及其對預后的影響. 中國普外基礎與臨床雜志, 2018, 25(11): 1327-1331.
5. 周魁平, 丁祥飛, 吳云陽, 等. 早期胃癌淋巴結轉移與臨床病理特征相關危險因素分析. 基因組學與應用生物學, 2018, 37(2): 618-623.
6. 張波, 令狐恩強, 柴寧莉, 等. 內鏡黏膜下剝離術治療早期胃癌中脈管癌栓相關因素分析. 臨床軍醫雜志, 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. 朱信強, 張明, 丁闖, 等. 不同病理類型進展期胃癌的預后因素分析. 中國普外基礎與臨床雜志, 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. 程樹群, 孫居仙. 肝癌合并門靜脈癌栓的診治進展. 中國普外基礎與臨床雜志, 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. 周儉, 肖永勝, 樊嘉. 肝癌合并門靜脈癌栓的研究進展. 中國普外基礎與臨床雜志, 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-Nú?ez 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. 馬麗華, 錢屹崟, 吳劍平, 等. D-二聚體和腫瘤標記物在胃癌診斷中的價值. 江蘇醫藥, 2014, 40(17): 2019-2021.
24. 杜彬, 陳強. 血漿D-二聚體水平與轉移性胃癌臨床特征及生存期相關分析. 福建醫科大學, 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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