Differentiating benign and malignant neoplasms: A possible new role for coagulation and fibrinolysis indicators

Abstract

Abstract Background: Abnormal coagulation and fibrinolysis are often observed in malignant tumors, which are closely related to the invasiveness of tumors. The aim of this study was to investigate the potential use of coagulation and fibrinolysis markers for differentiating between benign and malignant tumors. Methods: The levels of PT, APTT, TT, FIB, FDP, and D-dimer were analyzed in primary tumors (208 benign and 243 malignant) prior to biopsy or treatment. Additionally, a control group consisting of 400 healthy volunteers was included. Results:Significantly higher levels of PT, FIB, FDP and D-dimer were found in the malignant tumor group compared with both the benign tumor group and control group (P＜0.01). Multivariate logistic regression analysis showed that FIB was an important predictor of malignancy.The AUCs for FIB and D-dimer in differential diagnosing malignant tumors were 0.757（95% CI:0.692~0.821)and 0.790(95% CI:0.727~0.853), respectively. - both exceeding 0.75; their specificities for detecting malignancy were also high at 88.33% and 81.67%, respectively; while their positive predictive values reached up to 92.93% and 90.68%, respectively. The thresholds for the identification of malignant patients using the Youden index and were determined to be 3.185, and 0.335, respectively. The multivariate analysis indicated that FIB (≥3.185) (OR: 6.021, 95% CI: 2.290-15.828, P<0.001) and DD (≥0.335) (OR: 4.139, 95% CI: 1.420-12.060, P<0.01) demonstrated significant differences with the lower group.Furthermore, the combined detection of PT,FIB,D-dimer,and FDP could achieve an even higher diagnostic accuracy with AUCs was 0.834;specificities for detecting malignancy were 88.33%,while their positive predictive values were 93.58%. Finally, a combination factor involving these markers could provide valuable assistance in distinguishing between benign and malignant tumors. Conclusion: FIB(≥3.185) and D-dimer (≥0.355) alone and PT, FIB, FDP and D-dimer in combination are more suitable for the differential diagnosis of benign and malignant tumors.