Clinical Evaluation of Plasma Coagulation Parameters in Patients with Advanced-stage Non-small cell Lung Cancer Treated with Palliative Chemotherapy in China

Lung Cancer

Int J Clin Pract. 2020 Jul 29:e13619. doi: 10.1111/ijcp.13619. Online ahead of print.


AIMS OF THE STUDY: Blood coagulation assays are colossally important for clinical evaluation of palliative chemotherapy; however, this niche was not explored earlier for advanced-stage non-small cell lung cancer (NSCLC). Study focuses to explore the clinical relevancy of Coagulation assays; prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), D-dimer and international normalised ratio (INR) and their response to palliative chemotherapy in advanced stage NSCLC.

METHODS: A retrospective study was conducted between 2013 and 2019 in Jiangsu Cancer hospital, Nanjing, PR. China. Medical records of 5445 patients were succinctly reviewed and classified accordingly to the inclusion and exclusion criteria. A total of 216 advanced NSCLC patients who used a first line chemotherapy and antiangiogenic therapy regimen were enrolled in this study under ethical approval (JSCH-2020C-009). Blood samples were collected from these patients to measure the response levels of these coagulation parameters at time of admission to hospital and at the beginning of 4 cycles of Palliative therapy. We find the clinical value of all these coagulation parameters by using SPSS 24. Univariate Cox regression and Multivariate Cox regression models were used to identify the factors that were associated with progression free survival (PFS) and the response to palliative chemotherapy.

RESULTS: In the Kaplan-Meier survival analysis for overall median (95%CI) survival of high pre-treatment coagulation parameters showed shorter PFS compared to normal pre-treatment except TT and their overall median (95%CI) follow up was 3.3(3.12-3.47). Coagulation parameters have showed clinical relevance as a potential independent prognostic factor of PFS in the Univariate Cox regression. In multivariable model, Age (≥ 60 years vs. <60 years), cancer differentiation (Unknown vs. Poor), PT (High vs. Normal) range, FIB (High vs. Normal) range, and D-dimer (High vs. Normal) range, (p = 0.025, p = 0.045, p = 0.029, p = 0.049, and p = 0.011 respectively) were associated as a prognostic factor of PFS in NSCLC. Patients on 3-drugs regimen found to have better PFS compared to the ones taking the 2-drugs treatment regimen (p= 0.043).

CONCLUSION: The high range of PT, FIB, and D-dimers was associated with poor prognosis of advanced-stage NSCLC. Our findings also confirmed that patients on 3-drugs regimen showed longer PFS compared to 2-drugs regimen.