Routine coagulation molecules predict nasopharyngeal carcinoma and associated metastases

ABSTRACT

Introduction: Most patients with malignant solid tumours have abnormal blood coagulation and an abnormal peripheral blood count, but data on nasopharyngeal carcinoma is scare. We hypothesised abnormal coagulation indices and red cell distribution width (RDW) in this group that are linked to the tumour (T), lymph node (N) and metastatic aspects (M) of the patients.

Methods: We recruited 740 newly diagnosed patients with nasopharyngeal carcinoma and 238 healthy controls, taking venous blood for prothrombin time, activated partial thromboplastin time (APTT), thrombin time, fibrinogen, fibrin degradation products (FDP), D-dimer, RD), platelets and platelet distribution width (PDW). In the patients, lab indices were analysed according to clinical stage.

Results: All indices except thrombin time were significantly different between cases and controls (p < 0.001), and many predicted TNM classifications and early or late stage of the disease. In sensitivity/specificity analysis, the prothrombin time, APTT and PDW gave AUCs >0.7, and in combination gave an AUC of 0.88 (95% CI 0.86–0.91) for nasopharyngeal carcinoma. No index provided an AUC >0.7 for T or N classification, or early v late stage, but APTT, fibrinogen and FDP all gave AUCs ≥0.7 for predicting metastases. Together, these three indices gave an AUC of 0.84 (0.78–0.91).

Conclusions: Routine coagulation indices can predict nasopharyngeal carcinoma, with the combination of prothrombin time, APTT and PDW being strongest. The combination of APTT, fibrinogen and FDPs provides a useful score to predict metastases. These indices should be considered in the diagnosis and staging of this disease.

KEYWORDS:

• Nasopharyngeal carcinoma
• coagulation function
• blood cell count

Acknowledgements

We thank the patients, their families, and the study teams who participated in the investigation. The authors also thank Jianxin Zhang from Guangxi University of Science and Technology for his help preparing data for this manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study is funded by the corresponding author himself.