Differential diagnosis value of D-dimer before operation in renal oncocytoma and chromophobe renal cell carcinoma

doi:10.3760/cma.j.cn371439-20230612-00116

Abstract

Abstract:

Objective To explore the differential diagnosis value of preoperative D-dimer in renal oncocytoma （RO） and chromophobe renal cell carcinoma （Ch-RCC）. Methods From January 2015 to April 2022 in the Second Hospital of Anhui Medical University， clinical data of 47 cases of rare renal tumors were collected. According to postoperative pathology， patients were divided into RO group （15 cases） and Ch-RCC group （32 cases）. General clinical data and preoperative blood indicators were analyzed. Receiver operator characteristic （ROC） curve and area under the curve （AUC） were performed to evaluate the differential diagnosis value of D-dimer between RO and Ch-RCC. Results There were no significant differences between two groups in gender （χ²=0.41， P=0.522）， age （t=0.50， P=0.618）， hypertension （χ²<0.01， P=0.994）， diabetes （P=0.541）， smoking history （χ²=1.67， P=0.196）， tumor laterality （χ²=0.67， P=0.414）. Besides， preoperative D-dimer was significantly higher in the Ch-RCC group [0.47 （0.29，0.77） μg/ml] in comparison with RO group [0.21 （0.19，0.27） μg/ml]， with a statistically significant difference （Z=4.44， P<0.001）. In addition， there were no significant differences in hemoglobin （t=-1.61， P=0.116）， platelet （t=0.26， P=0.800）， leucocyte （t=0.10， P=0.921）， neutrophil （t=-0.87， P=0.390）， lymphocyte （Z=0.82， P=0.418）， monocyte （Z=1.43， P=0.153）， neutrophil-lymphocyte ratio （Z=0.09， P=0.927）， platelet-lymphocyte ratio （t=0.42， P=0.676）， and lymphocyte-monocyte ratio （Z=-0.96， P=0.338） between Ch-RCC group and RO group. ROC curve analysis showed that when the cut-off value of preoperative D-dimer was 0.78 μg/ml， the AUC for differential diagnosis of RO and Ch-RCC was 0.90 （95%CI： 0.82-0.99， P<0.001）， with a sensitivity of 0.78 and a specificity of 1.00. Conclusion Preoperative level of D-dimer is significantly increased in Ch-RCC patients， which exhibits favourable preoperative differential diagnosis value between Ch-RCC and RO.

Key words: Fibrin fibrinogen degradation products, Kidney neoplasms, Diagnosis， differential

Qian Weiwei, Xu Shen, Kong Qi. Differential diagnosis value of D-dimer before operation in renal oncocytoma and chromophobe renal cell carcinoma[J]. Journal of International Oncology, 2023, 50(10): 614-617.

Figures/Tables 3

References 18

[1]	Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European association of urology guidelines on renal cell carcinoma: the 2022 update[J]. Eur Urol, 2022, 82(4): 399-410. DOI: 10.1016/j.eururo.2022.03.006. pmid: 35346519
[2]	He X, Huang T, Xue Y, et al. Association of preoperative plasma D-dimmer and fibrinogen and renal cell carcinoma outcome[J]. J Cancer, 2019, 10(17): 4096-4105. DOI: 10.7150/jca.31173. pmid: 31417654
[3]	Wang J, Li H, Xu R, et al. The MLR, NLR, PLR and D-dimer are associated with clinical outcome in lung cancer patients treated with surgery[J]. BMC Pulm Med, 2022, 22(1): 104. DOI: 10.1186/s12890-022-01901-7. pmid: 35337299
[4]	Otsu T, Hayashi M, Takami H, et al. High preoperative serum D-dimer predicts unfavorable survival outcomes for pancreatic cancer patients[J]. Anticancer Res, 2023, 43(7): 3173-3181. DOI: 10.21873/anticanres.16491. pmid: 37352000
[5]	Ren Z, Yang J, Liang J, et al. Monitoring of postoperative neutrophil-to-lymphocyte ratio, D-dimer, and CA153 in: diagnostic value for recurrent and metastatic breast cancer[J]. Front Surg, 2022, 9: 927491. DOI: 10.3389/fsurg.2022.927491.
[6]	Li Y, Huang X, Xia Y, et al. Value of radiomics in differential diagnosis of chromophobe renal cell carcinoma and renal oncocytoma[J]. Abdom Radiol (NY), 2020, 45(10): 3193-3201. DOI: 10.1007/s00261-019-02269-9. pmid: 31664486
[7]	Qu J, Zhang Q, Song X, et al. CT differentiation of the oncocytoma and renal cell carcinoma based on peripheral tumor parenchyma and central hypodense area characterisation[J]. BMC Med Imaging, 2023, 23(1): 16. DOI: 10.1186/s12880-023-00972-0. pmid: 36707788
[8]	Li X, Ma Q, Nie P, et al. A CT-based radiomics nomogram for differentiation of renal oncocytoma and chromophobe renal cell carcinoma with a central scar-matched study[J]. Br J Radiol, 2022, 95(1129): 20210534. DOI: 10.1259/bjr.20210534.
[9]	王国杰, 秦培鑫, 陈相猛, 等. 病灶大小对肾脏嗜酸细胞腺瘤及嫌色细胞癌CT征象的影响[J]. 中华介入放射学电子杂志, 2022, 10(1): 56-60. DOI: 10.3877/cma.j.issn.2095-5782.2022.01.010.
[10]	Uchida Y, Yoshida S, Arita Y, et al. Apparent diffusion coefficient map-based texture analysis for the differentiation of chromophobe renal cell carcinoma from renal oncocytoma[J]. Diagnostics (Basel), 2022, 12(4): 817. DOI: 10.3390/diagnostics12040817.
[11]	Hara K, Aoyama T, Hayashi T, et al. Postoperative D-dimer elevation affects tumor recurrence and the long-term survival in gastric cancer patients who undergo gastrectomy[J]. Int J Clin Oncol, 2020, 25(4): 584-594. DOI: 10.1007/s10147-019-01603-x. pmid: 31865480
[12]	Li X, Shu K, Zhou J, et al. Preoperative plasma fibrinogen and D-dimer as prognostic biomarkers for non-muscle-invasive bladder cancer[J]. Clin Genitourin Cancer, 2020, 18(1): 11-19.e1. DOI: 10.1016/j.clgc.2019.10.025.
[13]	Watanabe A, Araki K, Harimoto N, et al. D-dimer predicts postoperative recurrence and prognosis in patients with liver metastasis of colorectal cancer[J]. Int J Clin Oncol, 2018, 23(4): 689-697. DOI: 10.1007/s10147-018-1271-x. pmid: 29574651
[14]	Dirix LY, Oeyen S, Buys A, et al. Coagulation/fibrinolysis and circulating tumor cells in patients with advanced breast cancer[J]. Breast Cancer Res Treat, 2022, 192(3): 583-591. DOI: 10.1007/s10549-021-06484-1.
[15]	Tieken C, Versteeg HH. Anticoagulants versus cancer[J]. Thromb Res, 2016, 140(Suppl 1): S148-S153. DOI: 10.1016/S0049-3848(16)30114-1.
[16]	Dai H, Zhou H, Sun Y, et al. D-dimer as a potential clinical marker for predicting metastasis and progression in cancer[J]. Biomed Rep, 2018, 9(5): 453-457. DOI: 10.3892/br.2018.1151. pmid: 30402229
[17]	Guo J, Gao Y, Gong Z, et al. Plasma D-dimer level correlates with age, metastasis, recurrence, tumor-node-metastasis classification (TNM), and treatment of non-small-cell lung cancer (NSCLC) patients[J]. Biomed Res Int, 2021, 2021: 9623571. DOI: 10.1155/2021/9623571.
[18]	Erdem S, Amasyali AS, Aytac O, et al. Increased preoperative levels of plasma fibrinogen and D dimer in patients with renal cell carcinoma is associated with poor survival and adverse tumor characteristics[J]. Urol Oncol, 2014, 32(7): 1031-1040. DOI: 10.1016/j.urolonc.2014.03.013. pmid: 25027687

临床特征	RO组（n=15）	Ch-RCC组（n=32）	χ²/t值	P值
性别
男	6（40.00）	16（50.00）	0.41	0.522
女	9（60.00）	16（50.00）	0.41	0.522
年龄（岁）	55.73±0.51	53.84±12.19	0.50	0.618
高血压
有	3（20.00）	8（25.00）	<0.01	0.994
无	12（80.00）	24（75.00）	<0.01	0.994
糖尿病
有	1（6.67）	1（3.13）		0.541
无	14（93.33）	31（96.87）		0.541
吸烟史
有	1（6.67）	9（28.13）	1.67	0.196
无	14（93.33）	23（71.87）	1.67	0.196
肿瘤侧别
左	8（53.33）	13（40.63）	0.67	0.414
右	7（46.67）	19（59.37）	0.67	0.414

指标	RO组（n=15)	Ch-RCC组（n=32)	t/Z值	P值
血红蛋白（g/L）	124.40±14.46	133.38±19.22	-1.61	0.116
血小板（×10⁹/L）	232.53±77.51	227.50±55.17	0.26	0.800
白细胞（×10⁹/L）	5.70±1.84	5.66±1.31	0.10	0.921
中性粒细胞（×10⁹/L）	2.98±0.87	3.26±1.07	-0.87	0.390
淋巴细胞（×10⁹/L）	1.59（1.47，1.74）	1.69（1.34，1.90）	0.82	0.418
单核细胞（×10⁹/L）	0.33（0.28，0.49）	0.44（0.40，0.49）	1.43	0.153
中性粒细胞与淋巴细胞比值	1.94（1.62，2.15）	1.90（1.42，2.42）	0.09	0.927
血小板与淋巴细胞比值	150.22±47.09	143.89±48.48	0.42	0.676
淋巴细胞与单核细胞比值	3.89（2.85，6.13）	3.54（3.02，4.48）	-0.96	0.338
D二聚体（μg/ml）	0.21（0.19，0.27）	0.47（0.29，0.77）	4.44	<0.001