br Patient characteristics br nosed with advanced pancreatic
nosed with advanced pancreatic adenocarcinoma from January 1,
primary treatment at Fudan University Shanghai Cancer Center.
Patients who met the following criteria were enrolled in this GSK1838705A study.
tologically or cytologically confirmed. 2) The tumors were staged
according to the 8th edition of the American Joint Committee on
Cancer (Chicago, IL, USA) . Patients with stage III and IV tumors
were recruited. 3) No other primary malignant tumors were found
during treatment. The exclusion criteria included a lack of complete PCT 0.3 297 92.8%
clinicopathological and follow-up data, tumors not originating
from the pancreas, acute inflammatory diseases, a history of
thrombosis or treatment with drugs that might influence the he-
The primary endpoint was OS, which was calculated from the female. The median age was 60 (range from 30 to 81). Additionally,
date of diagnosis to the date of either death or the last follow-up
88 patients (27.5%) were diagnosed with locally advanced disease
time in the study. An independent researcher performed the
follow-up work by conducting telephone interviews or reviewing
diagnosed with metastatic disease and classified as stage IV. The
medical records. The last follow-up date was December 31, 2017.
median survival times are shown in Table 2. The median overall
Written informed consent was obtained from all patients. This
study was approved by the Ethics Board of the Fudan University
Shanghai Cancer Center. Association between hemostatic parameters and overall survival
Laboratory measurements To determine the prognostic value of the hemostatic system in
All laboratory parameters, including hemostatic parameters, advanced pancreatic cancer, clinical characteristics including
were assayed during routine workups before cancer diagnostic gender, age, TNM stage, and CA19-9 as well as hemostatic system
parameters including PT, APTT, INR, FBG, PLT, MPV, PCT, and PDW
interventions. Data was extracted from the Electronic Medical Re-
were subjected to the univariate and multivariate analyses using
cord System of Fudan University Shanghai Cancer Center.
Statistical analysis Table 2
Median survival according to different subsets.
Patient characteristics before diagnosis or first treatment were reported using descriptive statistics. The optimal cut-off levels of continuous variables were calculated by X-tile software . Sur-vival curves were calculated using the KaplaneMeier method, and the log-rank test was used to estimate the significance of differ-ences in survival. Univariate and multivariate analyses were per-formed using the Cox proportional hazards regression model in SPSS version 21.0 (IBM Corp, Armonk, NY, USA). Variables with p < 0.05 in the univariate analysis were included as candidates in a multivariate Cox regression model. A p-value <0.05 was considered significant.
Characteristics Parameter Median survival time 95% CI
Combining PT, FBG, and MPV as a scoring system to predict prognosis
the combination of these three hemostatic parameters might serve as a novel method for predicting the OS and showed greater pre-dictive power than that of each single factor.
Recently, mounting evidence suggests that the hemostatic sys-tem and cancer are closely linked by multiple mechanisms [21,22]. The process of hemostasis involves vasoconstriction, the activation, adhesion, and aggregation of platelets in addition to the deposition and maturation of fibrin. Cancer cells secrete various factors such as cytokines (e.g., interleukin-6, tumor necrosis factor-a), hemostatic factors (e.g., tissue factor, microparticles, fibrinolysis proteins) and adhesion molecules (e.g., vWF, GPII/IIIa, fibronectin) . Thus, cancer cells may interact with any step of the hemostatic process. Pancreatic cancer also induces a prothrombotic and hypercoagu-lable state by secreting procoagulant factors [e.g., tissue factor (TF), platelet factor 4 (PF4), plasminogen activator inhibitor type 1 (PAI-1)] . We also found that patients with increased hemostatic parameters were more likely to develop thrombosis and have poor survival in clinical practice. Therefore, we would like to explore the relation between hemostatic system parameters and the prognosis of advanced pancreatic cancer.