Application value of combined coagulation function indicators in monitoring hypercoagulable state of patients with colorectal cancer after chemotherapy

doi:10.19401/j.cnki.1007-3639.2024.03.005

Abstract

Abstract:

Background and purpose: The plasma used for routine coagulation test (CCT) can only reflect a single component at a certain coagulation time point/segment, while thromboelastography (TEG) can depict the overall dynamic process curve of coagulation and fibrinolysis, which can more independently and completely reflect the true state of the blood and can serve as a supplement to coagulation function testing. This study aimed to evaluate the application value of combined coagulation function indexes in monitoring the hypercoagulable state of patients with colorectal cancer after chemotherapy, and to explore the risk factors of thrombosis in patients with colorectal cancer after chemotherapy, so as to provide reference for clinical monitoring of hypercoagulable state. Methods: A total of 160 patients with colorectal cancer from Fudan University Shanghai Cancer Center from June 2021 to June 2023 were selected as the experimental group, and 80 healthy subjects were selected as the control group. Then the experimental group was divided into a group without thrombosis (82 cases) and a group with thrombosis (78 cases) according to whether they had thrombosis or not. The determinations of thromboelastography (TEG) [coagulation reaction time (R), coagulation formation time (K), blood clot formation rate (α-Angle), maximum amplitude (MA) and coagulation index (CI)], conventional coagulation tests (CCT) [activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (Fib), D-dimer (DD), fibrinogen degradation products (FDP)] and platelet count (PLT) were studied among three groups. With or without thrombosis as the criterion of hypercoagulable state, statistically significant indicators were selected to be included in the binary logistic regression analysis, and the receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic efficacy of single and combined detection of the coagulation function indicators for hypercoagulable state in patients with colorectal cancer after chemotherapy. Basic information, tumor stage and Autar score of deep vein thrombosis were collected in 160 patients with colorectal cancer. Logistic regression analysis was performed to explore the risk factors of thrombosis. This study was approved by the Ethics Committee of Fudan University Shanghai Cancer Center (number: 050432-4-2108*). Results: Compared with the control group, the R, TT and PLT of the group with thrombosis were decreased (P<0.05), while APTT, PT, DD and FDP were increased (P<0.05). The differences in various indicators between the group with thrombosis and the control group were statistically significant (P<0.05). Compared with the group without thrombosis, the K in the group with thrombosis decreased (P<0.05), while Angle, MA, CI, FIB, DD and FDP all increased (P<0.05). ROC curve analysis showed that in the assessment of hypercoagulable state in patients with colorectal cancer after chemotherapy, the area under curve (AUC) of TEG was 0.756, sensitivity was 67.5%, and specificity was 73.8%. The AUC of CCT was 0.691, sensitivity was 78.8%, and specificity was 56.2%. The combined detection AUC was 0.840, sensitivity was 80.0%, and specificity was 77.5%. In the analysis of risk factors, tumor stage, distant metastasis and Autar score were correlated with thrombus formation in patients with colorectal cancer after chemotherapy (P<0.05), and the differences of the three risk factors in K, Angle, MA, CI, Fib, DD and FDP were statistically significant (P<0.05). Conclusion: K, Angle, MA, CI, Fib, DD and FDP are the main indicators to reflect the hypercoagulable state, and the combined detection of TEG and CCT can better reflect the coagulation state of patients with colorectal cancer after chemotherapy. Tumor stage Ⅲ to Ⅳ, distant metastasis and high Autar score are risk factors for thrombosis. The incidence of thrombosis can be reduced by monitoring the relevant coagulation indicators in the high-risk population.

Key words: Colorectal cancer, Chemotherapy, Thromboelastography, Conventional coagulation test, Thrombosis

CLC Number:

R735.3

LU Yue, LU Renquan, ZHANG Jie, ZHENG Hui. Application value of combined coagulation function indicators in monitoring hypercoagulable state of patients with colorectal cancer after chemotherapy[J]. China Oncology, 2024, 34(3): 278-285.

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Group	N	R/min	K/min	Angle (deg)	MA/mm	CI	PLT/(10⁹·L^-1)
Control group	80	6.05 (4.83, 7.73)	1.85 (1.33, 2.23)	61.90 (54.55, 68.88)	57.80 (53.80, 62.70)	0.55 (-1.25, 1.90)	235.0 (166.80, 295.00)
Colorectal cancer without thrombosis group	82	5.05^a (4.15, 6.13)	1.60 (1.30, 2.18)	65.60 (60.38, 70.58)	60.60 (52.10, 64.80)	0.90 (-1.00, 2.30)	179.0^a (136.00, 250.00)
Colorectal cancer with thrombosis group	78	4.65^a (3.83, 5.50)	1.30^ab (1.00, 1.78)	70.65^ab (63.63, 75.28)	65.35^ab (60.23, 71.13)	2.20^ab (0.63, 3.18)	170.0^a (129.0, 215.3)
Group	APTT/s	PT/s	TT/s	Fib/(g·L^-1)	DD/(μg·mL^-1)	FDP/(μg·mL^-1)
Control group	28.45 (25.80, 31.93)	11.30 (9.90, 12.33)	15.30 (11.55, 16.20)	3.03 (2.40, 3.91)	0.28 (0.17, 0.43)	1.70 (0.46, 3.27)
Colorectal cancer without thrombosis group	29.35^a (27.60, 31.55)	12.05^a (11.43, 12.58)	13.80^a (12.60, 14.30)	3.07 (2.70, 3.61)	0.80^a (0.41, 1.31)	2.61^a (1.44, 4.12)
Colorectal cancer with thrombosis group	29.95^a (28.23, 31.60)	12.10^a (11.40, 12.60)	13.75^a (12.73, 14.40)	3.48^ab (2.84, 3.78)	1.27^ab (0.57, 2.05)	3.36^ab (1.78, 6.09)

Characteristic	Case N	Colorectal cancer without thrombosis group	Colorectal cancer with thrombosis group	χ²	P value
Gender				0.254	0.614
Male	87	43 (49.4)	44 (50.6)
Female	73	39 (53.4)	34 (46.6)
Age/year				1.981	0.159
<60	92	52 (56.5)	40 (43.5)
≥60	68	30 (44.1)	38 (55.9)
Basis diseases				0.434	0.933
Hypertension	23	13 (56.5)	10 (43.5)
Diabetes	15	7 (46.7)	8 (53.3)
Hyperlipidemia	15	8 (53.3)	7 (46.7)
Other	107	54 (50.5)	53 (49.5)
Stage of cancer				7.754	0.005^*
Ⅰ-Ⅱ	54	36 (66.7)	18 (33.3)
Ⅲ-Ⅳ	106	46 (43.4)	60 (56.6)
Distant metastasis				5.383	0.020^*
No	116	66 (56.9)	50 (43.1)
Yes	44	16 (36.4)	28 (63.6)
Autar score				6.293	0.043^*
Low	10	8 (80)	2 (20)
Middle	104	56 (53.8)	48 (46.2)
High	46	18 (39.1)	28 (60.9)

Group	N	K/min	Angle/deg	MA/mm	CI	Fib/(g·L^-1)	DD/(μg·mL^-1)	FDP/(μg·mL^-1)
Ⅰ-Ⅱ	54	1.50 (1.28, 2.13)	65.60 (60.53, 71.55)	60.45 (52.25, 64.93)	0.85 (-1.00, 2.65)	3.09 (2.71, 3.61)	0.68 (0.41, 1.03)	2.43 (1.23, 3.66)
Ⅲ-Ⅳ	106	1.41 (1.10, 1.80)	69.85 (62.43, 73.53)	64.65 (59.38, 70.08)	1.60 (0.15, 2.95)	3.38 (2.81, 3.72)	1.39 (0.55, 2.34)	3.61 (1.67, 6.26)
P value		0.106	0.118	0.013	0.075	0.263	<0.001	<0.001

Group	N	K/min	Angle/deg	MA/mm	CI	Fib/(g·L^-1)	DD/(μg·mL^-1)	FDP/(μg·mL^-1)
No distant metastasis	116	1.50 (1.13, 1.89)	66.00 (61.83, 71.50)	61.20 (52.40, 65.98)	0.90 (-0.55, 2.30)	3.10 (2.70, 3.65)	0.85 (0.43, 1.53)	2.56 (1.45, 4.26)
Distant metastasis	44	1.20 (1.00, 1.80)	71.50 (63.08, 75.28)	67.65 (60.78, 73.15)	2.45 (0.73, 3.48)	3.48 (2.90, 3.76)	1.47 (0.57, 2.62)	4.34 (1.89, 7.59)
P value		0.063	0.010	<0.001	<0.001	0.053	0.014	0.005

Group	N	K/min	Angle/deg	MA/mm	CI	Fib/(g·L^-1)	DD/(μg·mL^-1)	FDP/(μg·mL^-1)
Low-risk group	10	1.80 (1.40, 2.58)	65.05 (52.50, 69.83)	62.10 (51.93, 65.65)	-0.80 (-2.80, 2.30)	2.98 (2.56, 3.16)	0.49 (0.39, 0.72)	1.64 (1.24, 2.03)
Middle-risk group	104	1.50 (1.13, 1.89)	66.50 (61.83, 71.50)	60.95 (52.40, 65.98)	0.95 (-0.33, 2.38)	3.29 (2.80, 3.65)	0.98^a (0.44, 1.87)	3.18^a (1.45, 4.55)
High-risk group	46	1.20 (1.00, 1.79)	71.50^b (64.20, 75.55)	67.65^b (60.60, 72.85)	2.40^ab (0.78, 3.43)	3.48 (2.83, 3.77)	1.25^a (0.57, 2.39)	3.31^a (1.86, 6.78)