Clinical value of coagulation index combination for metastasis and postoperative recurrence of renal cell carcinoma
Objective To explore the potential value of coagulation indicators and their combinations for metastasis and postoperative recurrence in renal cell carcinoma(RCC)patients.Methods A total of 39 RCC patients with metastasis and postoperative recurrence were enrolled,and the controls groups included 64 RCC patients without metastasis,15 patients with renal vascular leiomyoma/oncocy-toma and 118 patients with renal cysts.All the patients were diagnosed and hospitalized in the Department of Urology of Nanjing Hospi-tal of Chinese Medicine affiliated with Nanjing University of Chinese Medicine and Jinling Hospital affiliated with Nanjing University School of Medicine from January 2018 to June 2024.The coagulation indicators in the blood samples were measured.The levels of plas-ma prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and fibrinogen(Fib)were analyzed by clotting method.The levels of fibrinogen degradation products(FDP)and D-Dimer(DD)were analyzed by immunological turbidim-etry assay,and the levels of antithrombin Ⅲ(AT3)were analyzed by chromogenic substrate method,respectively.The differences of coagulation indicators between RCC patients with metastasis and postoperative recurrence and the controls were assessed by Mann-Whit-ney U test.The potential value of coagulation indicators and their combinations for predicating metastasis and postoperative recurrence in RCC patients was evaluated through Logistic regression and ROC curve analysis.Results The plasma levels of the seven coagulation indicators showed significant differences between the patients with RCC metastatic/recurrent and the controls(all with P＜0.05).The results of ROC curve analysis showed that the plasma levels of all the 7 coagulation index could distinguish the metastatic/recurrent RCC patients from the controls,and the DD level showed the highest value with the AUCROC=0.913(95％CI:0.859 to 0.967).Multi-ple logistic regression analysis revealed that the plasma levels of Fib,FDP,DD,and AT3 were associated with RCC metastasis/recur-rence.Logistic regression analysis combined with ROC curve analysis revealed that the panel of Fib,FDP,DD and AT3 had the best performance for discriminating RCC metastasis/recurrence along with the AUCROC of 0.920(95％CI:0.865 to 0.974).Conclusion Alterations of the levels of plasma Fib,DD,FDP and AT3 may be closely related to postoperative recurrence and metastasis in RCC patients,and the panel of Fib,FDP,DD and AT3 has the potential to serve as the monitoring and evaluation indicators for RCC recur-rence and metastasis.
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