Biopsy, Fine-Needle ; methods ; Bronchi ; diagnostic imaging ; pathology ; China ; Endosonography ; methods ; Humans ; Lung Neoplasms ; diagnosis

OBJECTIVETo assess the value of thrombotic biomarkers in estimation of venous thromboembolism (VTE) risk in cancer patients.

METHODSA total of 1473 cancer patients treated in the Tianjin Medical University General Hospital from 2009 to 201 were selected, including 845 males and 628 females in the age of 56 ± 17 years. The activities of von Willebrand factor antigen (vWF:Ag), factor VII (F VII:A), factor VIII (F VIII:A), antithrombin (AT:A), protein C (PC:A) and protein S (PS:A) were assayed using an ACL TOP 700 blood coagulation analyzer. The level of D-dimer (D-D) was assayed using the Biomerieux Mini Vidas Automated Immunoassay Analyzer. Receiver operating characteristic curve (ROC) was used to analyze the diagnostic performance of the parameters. Cox regression analysis model was applied to evaluate the effect on prognosis, and Kaplan-Meier curve was used to implement the survival analysis.

RESULTSThe levels of vWF:Ag, D-D, and F VIII:A were significantly higher in all the specified tumor groups ( except the other tumor group ) than that of the control groups (P < 0.05). F VIII:A was significantly higher than that in the control group in all tumor groups except the renal carcinoma, prostatic cancer, lymphoma groups and the other tumor group (P < 0.05). The PC:A level was significantly lower in all tumor patients groups than in the control group, except glioma, breast cancer, gastric carcinoma, renal carcinoma and the other tumors groups (P < 0.05). The PS: A level was significantly lower in all tumor groups than in the control group, except the glioma, breast cancer, prostatic cancer, lymphoma and the other tumors groups (P<0.05). The AT: A level was significantly lower in all tumor groups than in the control group (P<0.05). When the optimum cut-off point of vWF:Ag for VTE diagnosis was 192% in the cancer group, the area under ROC curve = 0.828 (95% CI: 0.716 to 0.939). When the optimum cut-off point of D-dimer for VTE diagnosis was 1484 ng/ml in the cancer group, the area under ROC curve = 0.915 (95% confidence interval: 0. 840 to 0.988). When the optimum cut-off point of PC: A for VTE diagnosis was 75.2% in the cancer group, the area under ROC curve = 0.764 (95% confidence interval: 0.630 to 0.898). The Cox analysis showed that age, surgery, chemotherapy and D-dimer were independent risk factors for VTE event within three months in cancer patients. The cumulative probability of VTE was increased significantly in the cancer patients if whose plasma D-dimer level was over the cut-off value.

CONCLUSIONSThe plasma D-dimer level is obviously increased in cancer patients, and there is a relevance to thrombosis risk stratification and VTE cumulative probability. It is with good diagnostic performance, and may be used as an effective marker in estimation of VTE risk within 3 months in cancer patients.

Aged ; Antithrombins ; blood ; Biomarkers ; blood ; Factor VII ; analysis ; Factor VIII ; analysis ; Female ; Fibrin Fibrinogen Degradation Products ; Humans ; Male ; Middle Aged ; Neoplasms ; blood ; Prognosis ; Protein C ; analysis ; Protein S ; analysis ; ROC Curve ; Regression Analysis ; Risk Assessment ; Risk Factors ; Venous Thromboembolism ; etiology ; von Willebrand Factor ; analysis

Objective To study the prevalence of thrombocytosis in patients with non-small-cell lung cancer (NSCLC) and its correlation with clinicopathological features.Methods 156 patients with advanced NSCLC were retrospectively analyzed.The platelets degree between the groups with different sex,age,smoking,histological type of advanced NSCLC was compared and analyzed statistically.The relationship between the platelet count and chemotherapy effects was analyzed.Single analysis and Cox regression analysis were used for TTP and OS.Results Compared with the healthy persons,Plt significantly elevated in group with advanced NSCLC (36.5 ％,57/156 vs 5.0 ％,5/100) (P ＜ 0.01),and thrombocytosis group responded poorly to chemotherapy (22.8 ％,13/57 vs 39.4 ％,39/99) (P ＜ 0.05).The TTP (3.0 months vs 5.2 months) and OS (11.2 months vs 14.2 months) of Plt elevated group were significantly shorter than those of normal group.Conclusion Thrombocytosis is closely related to progress and metastasis of advanced NSCLC.Platelet count can be used as an assistant index in the prognosis judgment of patients with advanced NSCLC.

Objective To discuss the serum value of human epididymis protein 4(HE4) in the diagnosis of lung can-cer and to analyse the serum levels of HE4 in different pathological types and TNM staging of lung cancer patients. Meth-ods Forty-seven patients with lung cancer and thirty-one healthy controls were selected to join this study. According to various pathological types and TNM staging, the selected lung cancer patients were divided into different subgroups under the two categories. The serum HE4 levels were compared between subgroups. ROC curves of serum HE4 level and serum CEA level were drawn for the diagnosis of lung cancer with the pathological diagnosis as the golden standard. Results There was significantly higher level of serum HE4 in lung cancer group[(253.47±170.03) pmol/L] than that of healthy group [(84.09±51.03) pmol/L](t=5.365). There were no significant differences in serum levels of HE4 between different pathological subgroups of lung cancer patients [non-small cell carcinoma group (241.34±161.81) pmol/L vs small cell carcinoma group (293.5±198.76) pmol/L, t=0.847;squamous cell carcinoma group (304.29±287.61) pmol/L, adenocarcinoma group (224.39± 122.15) pmol/L and small cell carcinoma group F=0.969;and different TNM staging subgroups [ (stageⅠ~Ⅲgroup (255.27± 183.04) pmol/L vs stageⅣgroup (288.16±216.49) pmol/L, t=0.528]. Compared with ROC curves of serum HE4 and serum CEA,the area under the curve (AUC) of serum HE4 (0.902) was larger than that of serum CEA(0.765),( P>0.001). When the serum level of HE4 was 149.145 pmol/L, the sensitivity and specificity in the diagnosis of lung cancer were 72.3% and 90.3%. When the serum level of CEA was 4.685μg/L, the sensitivity and specificity in the diagnosis of lung cancer were 57.4%and 83.9%. Conclusion The serum level of HE4 is a sensitive and specific tumor marker in lung cancer. There are no significant differences in the serum levels of HE4 between different pathological types and different TNM staging in lung cancer patients. The detection of serum levels of HE4 are useful for the diagnosis of lung cancer.

Objective To assess the value of thrombotic biomarkers in estimation of venous thromboembolism ( VTE) risk in cancer patients.Methods A total of 1473 cancer patients treated in the Tianjin Medical University General Hospital from 2009 to 201 were selected, including 845 males and 628 females in the age of 56±17 years.The activities of von Willebrand factor antigen ( vWF:Ag) , factorⅦ( FⅦ:A), factor Ⅷ (FⅧ:A), antithrombin (AT:A), protein C (PC:A) and protein S (PS:A) were assayed using an ACL TOP 700 blood coagulation analyzer.The level of D-dimer ( D-D) was assayed using the Biomerieux Mini Vidas Automated Immunoassay Analyzer.Receiver operating characteristic curve ( ROC) was used to analyze the diagnostic performance of the parameters.Cox regression analysis model was applied to evaluate the effect on prognosis, and Kaplan-Meier curve was used to implement the survival analysis.Results The levels of vWF:Ag, D-D, and FⅧ:A were significantly higher in all the specified tumor groups ( except the other tumor group ) than that of the control groups ( P<0.05 ) .FⅧ:A was significantly higher than that in the control group in all tumor groups except the renal carcinoma, prostatic cancer, lymphoma groups and the other tumor group ( P<0.05) .The PC:A level was significantly lower in all tumor patients groups than in the control group, except glioma, breast cancer, gastric carcinoma, renal carcinoma and the other tumors groups ( P<0.05) .The PS:A level was significantly lower in all tumor groups than in the control group, except the glioma, breast cancer, prostatic cancer, lymphoma and the other tumors groups (P<0.05).The AT:A level was significantly lower in all tumor groups than in the control group (P<0.05).When the optimum cut-off point of vWF:Ag for VTE diagnosis was 192%in the cancer group, the area under ROC curve=0.828 ( 95%CI:0.716 to 0.939) .When the optimum cut-off point of D-dimer for VTE diagnosis was 1484 ng/ml in the cancer group, the area under ROC curve=0.915 ( 95%confidence interval: 0.840 to 0.988).When the optimum cut-off point of PC:A for VTE diagnosis was 75.2%in the cancer group, the area under ROC curve=0.764 ( 95%confidence interval:0.630 to 0.898) . The Cox analysis showed that age, surgery, chemotherapy and D-dimer were independent risk factors for VTE event within three months in cancer patients.The cumulative probability of VTE was increased significantly in the cancer patients if whose plasma D-dimer level was over the cut-off value.Conclusions The plasma D-dimer level is obviously increased in cancer patients, and there is a relevance to thrombosis risk stratification and VTE cumulative probability.It is with good diagnostic performance, and may be used as an effective marker in estimation of VTE risk within 3 months in cancer patients.

In recent years, it has been well known that non-small cell lung cancer (NSCLC) patients with muta-tions of epidermal growth factor receptor (EGFR) response better to EGFR-tyrosine kinase inhibitor treatment. Although DNA-based assays (e.g. DNA sequencing) are the most frequently used and a relatively reliable method to detect EGFR muta-tions, they are complex, time-consuming and relatively expensive for routine use in clinical laboratories, besides they require high quality tumor samples. In contrast, the immunohistochemistry (IHC) methods make up fully for the above shortcomings and can serve as screening tests for EGFR mutations. However, there are many factors that can inlfuence the results of IHC methods, such as different staining procedures, different antigen retrieval solutions and different sets of criteria, etc. hTus the IHC methods for detecting EGFR mutations have not been widely used in clinic and only in the research stage. hTis article re-views the use of IHC methods by different researchers and further discusses how to make the IHC methods work best for the detection of EGFR mutations.

Human epididymis 4 (HE4) belongs to whey acidic 4-disulfide center protein family. It has the char-acteristics of inhibiting trypsin and high expression in the serum or malignant pleural eusion of patients with lung cancer. Clinical data showed that it has certain relevance to the diagnosis and prognosis of lung cancer. HE4 may be a new indicator of clinical diagnosis and prognosis evaluation.

Malignant pleural effusion (MPE ) is due tumor which arises from the mesothelium or metastases from tumor origniating other sites. In large, for undiagnosed unilateral pleural effusions, the most frequent and important diagnosis to be established or excluded is malignancy. Cell block is prepared from residual lfuid which is centrifuged or is naturally sedi-menting to obtain clots at the bottom of the container. hTe cell block technique is simple, relatively non-invasive, reproducible and has a high yield for malignant plerual effusion. It plays an important role in the diagnosis, guiding the treatment of maligant pleural effusion. Herein, we summarize the technologys which make the cell block, the differential diagnostic value when multiple sections of the cell block are processed for immunhistochemistry, advantages in the diagnosis of malignant pleural ef-fusion, the clinical value of gene screening in cell block. hTe aim of this article is to discuss the value of cell block in diagnosis of maligant pleural effusion.

Non-small cell lung cancer (NSCLC) patients, with sensitive epidermal growth factor receptor (EGFR) mutations react well to tyrosine kinase inhibitors (TKIs). However, the efficacy of TKIs on patients with the same mutant types differs dramatically. It is implied that the different quantities of mutant alleles could be one of the reasons underlying. Patients with high abundance of EGFR mutation might benefit more from TKIs. There are no universal standards for the definition of EGFR mutant abundance. Abundance could be semi-quantified according to the different sensitivities of detection methods, quantified with quantifying detection techniques such as digital PCR or next generation sequencing, or quantified based on the expression of mutant proteins. hTe different abundances of primary and metastatic diseases could reflect the heterogeneity of the tumors. The pre-treatment level or the dynamic change of EGFR mutant abundance could help observe the course of the diseases and predict the efficacy of TKIs. TKIs resistance could be detected by change of abundance prior to image manifesta-tions. Besides, the abundance of T790M could also predict drug efficacy and resistance of the first and third generation TKIs. Thus the detection of EGFR mutant abundance has important clinical significance. The standardization and correction of abun-dance needs more exploration.

Objective To assess the value of thrombotic biomarkers in estimation of venous thromboembolism ( VTE) risk in cancer patients.Methods A total of 1473 cancer patients treated in the Tianjin Medical University General Hospital from 2009 to 201 were selected, including 845 males and 628 females in the age of 56±17 years.The activities of von Willebrand factor antigen ( vWF:Ag) , factorⅦ( FⅦ:A), factor Ⅷ (FⅧ:A), antithrombin (AT:A), protein C (PC:A) and protein S (PS:A) were assayed using an ACL TOP 700 blood coagulation analyzer.The level of D-dimer ( D-D) was assayed using the Biomerieux Mini Vidas Automated Immunoassay Analyzer.Receiver operating characteristic curve ( ROC) was used to analyze the diagnostic performance of the parameters.Cox regression analysis model was applied to evaluate the effect on prognosis, and Kaplan-Meier curve was used to implement the survival analysis.Results The levels of vWF:Ag, D-D, and FⅧ:A were significantly higher in all the specified tumor groups ( except the other tumor group ) than that of the control groups ( P<0.05 ) .FⅧ:A was significantly higher than that in the control group in all tumor groups except the renal carcinoma, prostatic cancer, lymphoma groups and the other tumor group ( P<0.05) .The PC:A level was significantly lower in all tumor patients groups than in the control group, except glioma, breast cancer, gastric carcinoma, renal carcinoma and the other tumors groups ( P<0.05) .The PS:A level was significantly lower in all tumor groups than in the control group, except the glioma, breast cancer, prostatic cancer, lymphoma and the other tumors groups (P<0.05).The AT:A level was significantly lower in all tumor groups than in the control group (P<0.05).When the optimum cut-off point of vWF:Ag for VTE diagnosis was 192%in the cancer group, the area under ROC curve=0.828 ( 95%CI:0.716 to 0.939) .When the optimum cut-off point of D-dimer for VTE diagnosis was 1484 ng/ml in the cancer group, the area under ROC curve=0.915 ( 95%confidence interval: 0.840 to 0.988).When the optimum cut-off point of PC:A for VTE diagnosis was 75.2%in the cancer group, the area under ROC curve=0.764 ( 95%confidence interval:0.630 to 0.898) . The Cox analysis showed that age, surgery, chemotherapy and D-dimer were independent risk factors for VTE event within three months in cancer patients.The cumulative probability of VTE was increased significantly in the cancer patients if whose plasma D-dimer level was over the cut-off value.Conclusions The plasma D-dimer level is obviously increased in cancer patients, and there is a relevance to thrombosis risk stratification and VTE cumulative probability.It is with good diagnostic performance, and may be used as an effective marker in estimation of VTE risk within 3 months in cancer patients.