Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2023; 15(7): 1253-1261
Published online Jul 15, 2023. doi: 10.4251/wjgo.v15.i7.1253
Clinical association between coagulation indicators and bone metastasis in patients with gastric cancer
Xuan Wang, Jing-Ya Wang, Min Chen, Juan Ren, Xin Zhang
Xuan Wang, Min Chen, Juan Ren, Department of Radiotherapy and Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
Jing-Ya Wang, Department of Gastroenterology, Xi'an Children's Hospital, Shaanxi Research Institute for Pediatric Diseases, The Affiliated Children's Hospital of Xi'an Jiaotong University and National Regional Medical Center for Children (Northwest), Xi'an 710003, Shaanxi Province, China
Xin Zhang, Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
Author contributions: Wang X, Ren J and Zhang X designed the research study; Wang X, Wang JY and Chen M performed the research; Wang X analyzed the data and wrote the manuscript; all authors read and approve the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of First Affiliated Hospital of Xi’an Jiaotong University (Approval No. 2015-046).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that no competing interests exist.
Data sharing statement: Dataset available from the corresponding author at zhangxinzh@stu.xjtu.edu.cn
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin Zhang, MD, Doctor, Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an 710061, Shaanxi Province, China. zhangxinzh@stu.xjtu.edu.cn
Received: February 6, 2023
Peer-review started: February 6, 2023
First decision: March 15, 2023
Revised: March 16, 2023
Accepted: May 6, 2023
Article in press: May 6, 2023
Published online: July 15, 2023
Processing time: 156 Days and 5.7 Hours
Abstract
BACKGROUND

Bones are one of the most common target organs for cancer metastasis. Early evaluation of bone metastasis (BM) status is clinically significant. Cancer patients often experience a hypercoagulable state.

AIM

To evaluate the correlation between coagulation indicators and the burden of BM in gastric cancer (GC).

METHODS

We conducted a single-center retrospective study and enrolled 454 patients. Clinical information including routine blood examination and coagulation markers were collected before any treatment. Patients were grouped according to the status of BM. Receiver operating characteristic curves were used to assess diagnostic performance and determine the optimal cutoff values of the above indicators. Cutoff values, sensitivity and specificity were based on the maximum Youden index. Univariate and multivariate logistic regression analyses were used to evaluate the relationships between biomarkers and BM.

RESULTS

Of the 454 enrolled patients, 191 patients were diagnosed with BM. The receiver operating characteristic curve analysis suggested that prothrombin time (PT) [cutoff: 13.25; sensitivity: 0.651; specificity: 0.709; area under receiver operating characteristic curve (AUC) = 0.738], activated partial thromboplastin time (aPTT) (cutoff: 35.15; sensitivity: 0.640; specificity: 0.640; AUC = 0.678) and fibrin degradation products (FDP) (cutoff: 2.75; sensitivity: 0.668; specificity: 0.801; AUC = 0.768) act as novel predictors for BM. Based on multivariate logistic regression analysis, the results showed the independent correlation between PT [odds ratio (OR): 3.16; 95% confidence interval (CI): 1.612-6.194; P = 0.001], aPTT (OR: 2.234; 95%CI: 1.157-4.313; P = 0.017) and FDP (OR: 3.17; 95%CI: 1.637-6.139; P = 0.001) and BM in patients with GC. Moreover, age, carcinoembryonic antigen, erythrocyte and globulin were found to be significantly associated with BM.

CONCLUSION

Coagulation markers, namely PT, aPTT and FDP, might be potential predictors for screening BM in patients with GC.

Keywords: Gastric cancer; Bone metastasis; Coagulation markers; Risk factor; Activated partial thromboplastin time; Prothrombin time; Fibrin degradation products

Core Tip: Bones are one of the most common organs involved in cancer metastasis. Early evaluation of bone metastasis (BM) status is clinically significant. In this study, we confirmed that coagulation markers (prothrombin time, activated partial thromboplastin time and fibrin degradation products), carcinoembryonic antigen and globulin are independent risk factors for BM in patients with gastric cancer. Patients with these risk factors should be screened early for BM, which may significantly decrease mortality rates related to BM in patients with gastric cancer.