D-dimer to lymphocyte ratio can serve as a potential predictive and prognostic value in colorectal cancer patients with liver metastases

BACKGROUND

The intent of this research was to generate and investigate the D-dimer to lymphocyte ratio (DLR) capacity to forecast the risk and prognosis of colorectal cancer liver metastases (CRCLM).

METHODS

From January 2010 to December 2019, 177 clinicopathologically confirmed colorectal cancer (CRC) patients (89 in the control group and 88 in the experimental group) were identified at the Affiliated Cancer Hospital of Guangxi Medical University. Multivariate Cox regression analysis was used to screen independent predictive diagnostic and prognostic factors of liver metastasis in CRC, and receiver operating characteristic (ROC) curves and Kaplan‒Meier (K‒M) curves were established to analyze the diagnostic and predictive prognostic efficacy of the DLR in the development of CRCLM.

RESULTS

Patients with CRCLM had higher DLR levels and D-dimer levels in their blood, with statistically significant differences (p < 0.001). DLR might be employed as a predictor for the development of CRCLM, according to ROC curve research (sensitivity 0.670, specificity 0.775, area under the curve 0.765). D-dimer, lymphocyte count CEA, CA125, and CA199 were not linked to prognosis in patients with CRCLM in Cox regression analysis of dichotomous variables. In contrast, DLR level was a possible risk factor for the prognosis of patients with CRCLM (HR = 2.108, p = 0.047), and age, T stage, and DLR level (DLR < 0.4) were connected with the prognosis of patients with CRCLM (p < 0.05).

CONCLUSION

DLR serves as a risk indicator for the development of CRCLM.

D-Dimers Variability in the Perioperative Period of Breast Cancer Surgery Helps to Predict Cancer Relapse: A Single-Centre Prospective Study

BACKGROUND

The importance of D-dimers (DD) assessment in the diagnostic algorithm of venous thromboembolic (VTE) disease is well known. Increase of DD concentration may be also associated with neoplastic disease. Many studies documented that high concentration of DD before solid tumour surgery indicates more advanced disease and poor life expectancy. The prognostic value of the DD concentration variability in the perioperative period, in women undergoing breast cancer surgery, has not been analysed so far. Thus, the aim of the present prospective study was to assess whether the trend of DD concentration changes in the perioperative period may predict cancer recurrence in women undergoing breast cancer surgery.

MATERIALS AND METHODS

189 consecutive women with histopathological diagnosis of breast cancer (BC) referred for surgical treatment were included. DD concentration was measured twice in each patient: at the time of admission to hospital and at the time of discharge home. Enoxaparin in standard dose of 40 mg daily s. c. was used as primary VTE prophylaxis in all of the patients.

RESULTS

The recurrence of BC, within 1 year observation time, occurred in 13 patients (6.8%), in 11 (5.8%) patients with DD increase after surgery and only in 2 (1.1%) without an increase in DD, P = .0179. Increase in DD concentration after BC surgery was an independent positive predictor of disease relapse (OR 8.600, LCI 1.451, UCI 96.80, P = .0371) together with the lack of postoperative radiotherapy (OR 6.009, LCI 1.305, UCI 31.95, P = .0245), whereas the lack of postoperative chemotherapy predicted no BC relapse (OR .07355, LCI .0056, UCI .58, P = .0245).

CONCLUSIONS

Increase of DD in the early postoperative period may be considered as additional independent predictor of recurrence of BC within 1 year.

Thrombin Generation and D-Dimer for Prediction of Disease Progression and Mortality in Patients with Metastatic Gastrointestinal Cancer

Background: the tight and reciprocal interaction between cancer and hemostasis has stimulated investigations on the possible role of hemostatic biomarkers in predicting specific cancer outcomes, such as disease progression (DP) and overall survival (OS). In a prospective cohort of newly diagnosed metastatic gastrointestinal (GI) cancer patients from the HYPERCAN study, we aimed to assess whether the hemostatic biomarker levels measured before starting any anticancer therapy may specifically predict for 6-months DP (6m-DP) and for 1-year OS (1y OS). Methods: plasma samples were collected and tested for thrombin generation (TG) as global hemostatic assay, and for D-dimer, fibrinogen, and prothrombin fragment 1 + 2 as hypercoagulation biomarkers. DP and mortality were monitored during follow-up. Results: A prospective cohort of 462 colorectal and 164 gastric cancer patients was available for analysis. After 6 months, DP occurred in 148 patients, providing a cumulative incidence of 24.8% (21.4−28.4). D-dimer and TG endogenous thrombin potential (ETP) were identified as independent risk factors for 6m-DP by multivariate Fine−Gray proportional hazard regression model corrected for age, cancer site, and >1 metastatic site. After 1 year, we observed an OS of 75.7% (71.9−79.0). Multivariate Cox regression analysis corrected for age, site of cancer, and performance status identified D-dimer and ETP as independent risk factors for 1y OS. Patients with one or both hemostatic parameters above the dichotomizing threshold were at higher risk for both 6m-DP and 1-year mortality. Conclusion.: in newly diagnosed metastatic GI cancer patients, pretreatment ETP and D-dimer appear promising candidate biomarkers for predicting 6m-DP and 1y OS. In this setting, for the first time, the role of TG as a prognostic biomarker emerges in a large prospective cohort.

The Relationship Between D-dimer and Prognosis in the Patients with Serum Alpha-Fetoprotein-Positive Gastric Cancer: A Retrospective Cohort Study

Background:

Alpha-fetoprotein-positive gastric cancer (AFPGC) is a subtype of gastric cancer that is rare in clinical practice and extremely malignant. Malignant tumors are often associated with hemorrhage, thrombosis, and even disseminated intravascular coagulation (DIC). The D-dimer test is used as a sensitive index in the diagnosis of DIC and fresh thrombosis in malignant tumors. Therefore, this study aims to investigate the relationship between D-dimer values and the clinical characteristics and prognosis of patients with serum AFPGC (AFP ⩾ 15 μg/L) patients.

Methods:

Overall, 120 healthy subjects and 120 AFP-negative gastric cancer (AFP < 15μg/L) patients from May 2017 to July 2018 at the Shanxi Cancer Hospital served as the control group in this retrospective cohort study. Additionally, 120 patients with pretreatment advanced serum AFP were chosen to analyze clinicopathologic features and factors that affect prognosis. The predictor was the D-dimer, and the outcome variable was overall survival (OS). Other variables included age, sex, tumor site, T-stage, distant metastasis, and preoperative serum tumor biomarkers. Differences in OS rate were analyzed by GraphPad Prism 9.2.0.332. The Cox regression model was used for univariate and multivariate analysis.

Results:

In comparison to AFP-negative gastric cancer, we discovered that D-dimer had a meaningfully higher presentation in patients with AFPGC (P < .001). Based on D-dimer median levels, the AFPGC patients were divided into two groups, including 39 patients with low D-dimer (<1000 ng/mL) and 81 patients with high D-dimer (⩾1000 ng/mL). The variables, including T-stage, distant metastasis, and expression of HER2, were associated with the value of D-dimer. The D-dimer levels were weakly related to the levels of tumor markers. The differences in AFPGC patients, with an OS rate of 30.76% for patients with low D-dimer (<1000) and 12.30% with high D-dimer (⩾1000; P = .0027), were statistically significant. Cox multivariate analysis of various parameters indicated that T-stage, distant metastasis, vascular embolism, level of D-dimer, and tumor biomarkers of AFP were independent risk factors for survival.

Conclusion:

Serum D-dimer levels may be a valuable indicator for predicting AFPGC metastasis and progression.

Significance of preoperative blood tests in the prognosis of colorectal cancer: A prospective, multicenter study from Hungary

Background

The focus of this study was to analyze the prognostic value of different combinations of inflammatory and coagulation factors using preoperative blood and to appraise the clinical importance of these biomarkers in colorectal cancer patients.

Methods

A prospective, multicenter study included patients undergoing radical colorectal surgery in three county hospitals. Inflammatory and coagulation markers were analyzed preoperatively.

Results

Two hundred and one patients were included. We examined patients based on their tumor localization. Colon cancer group involved patients with the tumor localized in the colon (n = 105, 52.24%) and rectal cancer group the patients with the tumor in the rectum (n = 96, 47.76%). Examining coagulation factors, univariate Cox analysis of colon cancer patients showed that activated partial thromboplastin time (p = 0.020) was significantly associated with overall survival, but we could not prove it in multivariate analysis. In colon cancer patients, neutrophil‐to‐lymphocyte ratio (NLR, p < 0.001) was positively correlated with tumor size and had significant association (χ² = 5.48, p = 0.019, df = 1) with perineural invasion. Univariate and multivariate Cox analysis of colon cancer patients showed that NLR (p = 0.011 and p = 0.048) was significantly associated with disease‐free survival (DFS).

Conclusion

NLR was proved to be an independent prognostic factor for DFS in patients with non‐metastatic colon cancer. NLR might help to recognize the high‐risk patients between patients with the same tumor‐node‐metastasis stage and could help with the decision on adjuvant chemotherapy. Since the biomarkers in preoperative blood tests are habitually evaluated, NLR could be an inexpensive prognostic marker that can be easily assessed in clinical practice.

Prognostic role of preoperative D-dimer, fibrinogen and platelet levels in patients with oral squamous cell carcinoma

Background

The relationship between cancer and coagulation has been intensively studied in recent years; however, the effects of coagulation factors on oral squamous cell carcinoma (OSCC) have rarely been reported. This study aimed to investigate the relationship between preoperative D-dimer (DD), fibrinogen (FIB), platelets (PLT) and OSCC, as well as the prognostic value of DD, FIB and PLT in OSCC.

Methods

We retrospectively investigated a total of 202 patients with OSCC treated at Guanghua Hospital of Stomatology, Sun Yat-sen University. Baseline demographic and clinicopathological information as well as both preoperative and postoperative DD, FIB and PLT results were collected from each patient, and patients with primary OSCC were followed up for disease progression, death or the end of the study. The correlations between preoperative DD, FIB, PLT and other clinical features, as well as the therapeutic effect and PFS were analysed statistically, and postoperative DD and surgical parameters were also analysed.

Results

Preoperative DD was significantly correlated with T stage, N stage, clinical stage and relapse of OSCC (P = 0.000, 0.001, 0.000 and 0.000, respectively). Univariate Cox regression analyses showed that high preoperative DD predicted poor prognosis in patients with OSCC (HR = 2.1, P = 0.033), while FIB and PLT showed no prognostic values. Postoperative DD was significantly correlated with preoperative DD and surgical type but not the duration of surgery (P = 0.005, 0.001 and 0.244, respectively).

Conclusion

In this study, we suggested that high preoperative DD level may serve as an indicator for synchronous neck dissection in patients with T_{1, 2} OSCC, and the elevated DD level might be the marker of disease progression in patient follow up.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-07841-5.

Association between D-Dimer Levels and the Prognosis of Terminal Cancer Patients in the Last Hours of Life

Purpose

D-dimer levels are known to be associated with poor outcomes in patients with various cancers, but their significance at the end of life remains unclear. This study investigated D-dimer levels as a prognostic indicator for terminal cancer patients in the last hours of life.

Methods

The retrospective study was conducted at a palliative care unit of a tertiary cancer center, using a database to analyze the records of patients treated from January 1, 2010 to December 31, 2018. In total, 67 terminal cancer patients with available data on D-dimer levels were included. Patients' demographic data, clinical information, and laboratory values, including D-dimer levels, were collected. Survival was analyzed using the Kaplan-Meier method and the log-rank test. A Cox proportional-hazards model was used to identify prognostic factors of poor survival.

Results

The most common site of cancer was the lung (32.8%) and the median survival time was 5 days. Most laboratory results, particularly D-dimer levels, deviated from the normal range. Patients with high D-dimer levels had a significantly shorter survival time than those with low D-dimer levels (4 days vs. 7 days; P=0.012). In the Cox regression analysis, only a high D-dimer level was identified as a predictor of a poor prognosis (hazard ratio, 1.83; 95% confidence interval, 1.09~3.07).

Conclusion

Our results suggest that at the very end of life, D-dimer levels may serve as a prognostic factor for survival in cancer patients.

D-Dimer level was associated with prognosis in metastatic colorectal cancer: A Chinese patients based cohort study

D-dimer level is a direct measure of activated coagulation and has been used as a biomarker of hypercoagulability. In this study, we aimed to explore the associations between D-dimer level and the clinicopathological features and prognosis in metastatic colorectal cancer (mCRC) patients. One hundred seventy-eight patients diagnosed with mCRC from the Department of General Surgery, Jingmen First People's Hospital from September 2014 to December 2018 were collected. Data of coagulation index was evaluated and survival analysis was performed to identify the biomarker of mCRC. Among 178 cases of colorectal cancer, we found that the value of 0.55 mg/L, 5ng/ml and 40U/ml were cut-off values of D-Dimer, CEA and CA-199 for patients survival, respectively. hypercoagulability was much more frequent in patients aged ≥60 years than <60 years (P < .001) and also in patients with ECOG ≥2 points (P < .001). Moreover, those patients who have CEA >5ng/ml and CA-199>40U/ml had hypercoagulable state (P < .001). There was a significant difference in D-Dimer >0.55 mg/L and D-Dimer ≤0.55 mg/L among the number of metastatic sites (P < .01) and patients with comorbidities (P < .01). Survival analysis showed that patients with D-Dimer >0.55 mg/L have significantly unfavorable overall survival (P = .006) and progressive free survival (P = .011).

Differential Expression and Diagnostic Significance of Pre-Albumin, Fibrinogen Combined with D-Dimer in AFP-Negative Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is one of the most malignant cancers with high morbidity and mortality. Nowadays, AFP-negative hepatocellular carcinoma (AFP-NHCC) has been found in many HCC patients and AFP analysis can't be used to screen HCC in these cases. In this study, we have examined the expression patterns of pre-albumin (PA), fibrinogen, D-Dimer and their clinical significance in AFP-NHCC. We recruited 214 AFP-NHCC patients and 210 controls in the study. PA, fibrinogen and D-Dimer levels were detected by turbidimetry, clauss and immunoturbidimetry methods, respectively. Serum PA levels were significantly lower in AFP-NHCC (84.5 ± 24.7 mg/L) than that in the controls (240.6 ± 59.4 mg/L, P < 0.05). For plasma fibrinogen levels, there was no difference between the controls (2.9 ± 0.7 g/L) and AFP-NHCC (2.5 ± 0.7 g/L). Compared with AFP-NHCC (0.8 ± 0.2 mg/L), plasma D-Dimer levels were significantly lower in controls (0.1 ± 0.0 mg/L, P < 0.05). The levels of PA, fibrinogen and D-Dimer were significantly correlated with differentiation (P < 0.01), and the PA and D-Dimer values were correlated with TNM stage (P < 0.05). Moreover, PA levels were correlated with tumor size (P = 0.034). Receiver operating characteristic curve (ROC) analyses elaborated that combination of PA, fibrinogen and D-Dimer possessed a higher sensitivity (93.4%) for differentiating AFP-NHCC from the controls, but the diagnostic specificity was reduced due to the combination of fibrinogen. After adjusting for all significant outcome predictors of the univariate logistic regression analysis, low levels of PA and high levels of D-Dimer were remained independent unfavorable outcome predictors (P < 0.05). Our data suggested that the expression levels of PA, fibrinogen and D-Dimer played critical roles in AFP-NHCC tumorigenesis. Moreover, PA and D-Dimer might be considered as potential diagnostic indicators in AFP-NHCC.

High pretreatment plasma D-dimer levels predict poor prognosis in gastrointestinal cancers: A meta-analysis

BACKGROUND

High pretreatment plasma D-dimer levels can predict poor prognosis in various types of gastrointestinal carcinomas. Our meta-analysis explored the correlation between plasma D-dimer levels and prognosis in gastrointestinal malignancies.

METHODS

Two independent reviewers conducted a comprehensive search from PubMed, ScienceDirect, Embase, Web of Science and the Cochrane Library. All articles evaluating the correlation between pretreatment plasma D-dimer levels and prognosis in gastrointestinal malignancies were searched. We chose overall survival (OS) as the primary survival outcome measure and progression-free survival (PFS), disease-free survival (DFS) and cancer-specific survival (CSS) as the secondary survival outcome measures. We extracted hazard ratios (HRs) and 95% confidence intervals (CIs) from the eligible publications.

RESULTS

We included 30 studies involving 5928 gastrointestinal cancer patients. There was an obvious correlation between high D-dimer levels and poor OS (HR = 2.01, 95% CI = 1.72-2.36, P < .01). High plasma D-dimer levels were correlated with shorter PFS (HR = 1.34, 95% CI = 1.05-1.70, P = .32), DFS (HR =  1.67, 95% CI = 1.12-2.50, P < .01) and CSS rates (HR = 1.93, 95% CI = 1.49-2.49, P = .66).

CONCLUSIONS

Elevated pretreatment plasma D-dimer levels might help predict poor prognosis in patients with gastrointestinal malignancies.

Combination of D-dimer and carcinoembryonic antigen levels as a predictive and prognostic biomarker in advanced colorectal cancer patients

In view of the controversial findings on the utility of D-dimer and carcinoembryonic antigen (CEA) as biomarkers in advanced colorectal cancer (CRC), we evaluated the predictive and prognostic value of the D-dimer and CEA levels in unresectable advanced CRC patients treated with first-line chemotherapy. A total of 57 previously untreated patients with advanced CRC were enrolled. We assessed both plasma D-dimer and CEA levels at the start (D1 and CEA1) and after two cycles (D2 and CEA2) of chemotherapy. Based on the respective optimal cut-off values of 0.8 and 5.0 ng/mL for D1 and CEA1, respectively, patients were divided into low and high D-dimer or CEA groups. The results show that D1 and CEA1 levels were correlated (r = 0.392, P = 0.003). Mean CEA2 was reduced by 26.24 ng/mL in patients with partial response and stable disease and increased by 165.95 ng/mL in patients with progressive disease relative to the CEA1 level (P < 0.001). However, no correlation was evident between changes in the D-dimer levels and chemotherapy response (P = 0.441). The overall survival (OS) of patients with high D1 was shorter than that of patients with low D1 (median OS, 16 vs 29 months, P = 0.009). Multivariate analyses further demonstrated that D1 (P = 0.042) and chemotherapy response (P = 0.016), but not CEA, were independent prognostic factors for OS in advanced CRC. Taken together, our result found that changes in CEA levels may serve as a predictive biomarker of the chemotherapy response and baseline D-dimer levels as a prognostic biomarker of OS in patients with advanced CRC.

Prognostic Value of D-Dimer in Patients with Diffuse Large B-cell Lymphoma: A Retrospective Study

This study evaluated the significance of serum D-Dimer for predicting survival of patients with diffuse large B-cell lymphoma (DLBCL). We analyzed the clinical data from 113 patients who were newly diagnosed with DLBCL at Tongji Hospital from January 2012 to January 2016. The results indicated that there were higher levels of D-Dimer in DLBCL patients with the following characteristics: stage III/IV, lymphocyte monocyte ratio (LMR) <2.27, lactate dehydrogenase (LDH) > upper limit of normal (ULN), albumin (ALB) < 35 g/L, and anemia. After the first chemotherapeutic regimen, D-Dimer was significantly decreased concomitantly with LDH. Cox univariate regression analysis showed that the overall survival (OS) was negatively affected by the following factors: age > 60 years, stage III/W, LDH > ULN, LMR < 2.27, anemia and D-Dimer > 0.92. Multivariate analysis showed that only LDH > ULN (P=0.038) and age > 60 years (P=0.047) were independent adverse prognostic factors. However, it was suggested that D-Dimer could be regarded as a marker of high tumor burden and a potential prognostic screening tool for patients with DLBCL, not otherwise specified (NOS).

Plasma fibrinogen levels correlate with prognosis and treatment outcome in patients with non-M3 acute myeloid leukemia

To assess plasma fibrinogen levels as a biomarker to predict the prognosis and treatment outcome in acute myeloid leukemia (AML), a retrospective study of 215 patients with AML excluding M3 was conducted in a single center. Patients were divided into low and high group according to the cutoff value of 3.775 g/L obtained by analyzing the receiver operating characteristic (ROC) curve of fibrinogen at diagnosis. Importantly, overall survival (OS) was markedly better in low fibrinogen group (p=.006) as well as disease-free survival (DFS) (p= .045). Furthermore, when patients achieved complete remission (CR), the median plasma fibrinogen levels were dramatically decreased in high fibrinogen group but increased in low fibrinogen group. In conclusion, our data suggest that initial plasma FBG levels can be used as an independent prognostic biomarker affecting OS and DFS, as well as a potential parameter reflecting the treatment outcome in patients with non-M3 AML.

Prognostic value of the Glasgow prognostic score in colorectal cancer: a meta-analysis of 9,839 patients

Purpose

The aim of this study was to perform a systematic review and meta-analysis to evaluate the value of the Glasgow prognostic score (GPS) or modified Glasgow prognostic score (mGPS) in patients with colorectal cancer (CRC).

Methods

A comprehensive medical literature search was performed using the online databases PubMed, Embase, Web of Science, and the Cochrane Library. After extracting basic characteristics and prognostic data from the included studies, overall survival (OS) and cancer-specific survival (CSS) were pooled as primary outcomes. Subgroup analyses were performed according to therapeutic strategies, models, cutoff values, regions, tumor, node, metastasis stages, sample size, and ages.

Results

Forty-three independent cohorts from 41 studies with 9,839 CRC patients were included in the present study. Correlation between GPS or mGPS and OS was analyzed in 32 cohorts of 7,714 patients, and 23 independent cohorts of 5,375 patients focused on the correlation between GPS or mGPS and CSS. The overall outcomes showed that patients with elevated GPS or mGPS were associated with poor OS (HR: 2.20, 95% CI: 1.88–2.57, P<0.001). Elevated GPS or mGPS also resulted in worse CSS (HR: 1.86, 95% CI: 1.59–2.17, P<0.001). The results of the subgroup analyses confirmed the overall outcomes.

Conclusion

GPS or mGPS is an accurate prognostic predictor in patients with CRC. Patients with elevated pretreatment GPS or mGPS have a poor prognosis. Subgroup analyses confirmed the overall outcomes. Pretreatment GPS is a useful biomarker in the management of CRC.

Usefulness of plasma D-dimer level for monitoring development of distant organ metastasis in colorectal cancer patients after curative resection

Purpose

To investigate the usefulness of plasma D-dimer level for monitoring the development of distant organ metastasis in colorectal cancer (CRC) patients after curative resection.

Patients and methods

One hundred and seventy-eight CRC patients after curative resection were enrolled in the study. Ninety-two patients developed distant organ metastasis during follow-up (metachronous metastasis), and blood was collected on the day metastasis was confirmed. Eighty-six patients had no evidence of metastasis yet, and their blood samples were evaluated at last return visit. The levels of D-dimer, carcinoembryonic antigen (CEA), and lactate dehydrogenase (LDH) between two patient groups were compared. The agreement between D-dimer and CEA (or LDH) was examined. The receiver operator characteristic (ROC) curve was used to evaluate the performance of D-dimer, CEA, LDH, and their combination in detection of distant organ metastasis.

Results

The level of D-dimer in CRC patients with metachronous metastasis was higher than that in non-metastasis patients (P<0.0001). Agreement between D-dimer and CEA was fair (κ=0.416, P<0.0001). D-dimer had a larger area under ROC (AUC) (0.85) compared to CEA (0.72) or LDH (0.68). The specificity of D-dimer (73.3%) was lower than that of CEA (74.4%), but the sensitivity (88.0%) of D-dimer assay was superior to that of CEA assay (65.2%). LDH showed the lowest sensitivity (42.4%) and highest specificity (95.3%) among the three bio-markers. The sensitivity and negative predictive value (NPV) of a combination assay (either D-dimer elevation or CEA elevation) were 94.6% and 91.1%, respectively, and the specificity and positive predictive value of another combination assay (both D-dimer elevation and LDH elevation) were 97.7% and 94.9%, respectively. Parallel test of the three markers improved the sensitivity and NPV to 95.7% and 92.7%, respectively.

Conclusion

Combining with CEA and/or LDH, D-dimer could be a useful surveillance marker for distant organ metastasis in CRC patients after curative resection.

In silico thrombin generation: Plasma composition imbalance and mortality in human immunodeficiency virus

Background

Effective HIV treatment with antiretroviral therapy has prolonged survival and shifted causes of death to non-AIDS illnesses such as cardiovascular disease. We have shown that inflammation and HIV viral load associate with pro- and anticoagulant factor imbalances resulting in increased thrombin generation when mathematically modeled. We explore the hypothesis that factor compositional imbalance, corresponding to increased in silico thrombin generation, predicts mortality among HIV+ persons.

Methods

In a nested case-control study of HIV+ individuals on continuous antiretroviral therapy in two large trials, we evaluated cases (any non-violent mortality, n = 114) and matched controls (n = 318). Thrombin generation in response to a tissue-factor initiator for each individual was calculated by a mathematical model incorporating levels of factors (F)II, V, VII, VIII, IX, X, antithrombin, tissue factor pathway inhibitor, and protein C (PC) measured at study entry to the trials. In silico thrombin generation metrics included clot time, maximum rate (MaxR), maximum level (MaxL), and area under the curve (AUC).

Results

Levels of antithrombin and PC decreased, while FV and FVIII were higher in cases vs controls. This resulted in a more procoagulant phenotype with increased MaxR, MaxL, and AUC in cases compared to controls (P < 0.05 for all).

Conclusions

Antithrombin, FV, FVIII, and PC were the major contributors to the increased thrombin generation associated with mortality risk. Our results suggest that mortality in HIV is associated with an increase in in silico thrombin generation via altered balance of pro- and anticoagulant factors, likely due to an inflammatory response signal, and resulting coagulopathy.

D-dimer predicts postoperative recurrence and prognosis in patients with liver metastasis of colorectal cancer

BACKGROUND

Colorectal cancer is common, and its incidence is increasing throughout the world. The liver is a major metastatic site, and colorectal liver metastasis (CRLM) has a poor prognosis. Although liver resection is the most effective therapy for CRLM, postoperative recurrence is common. Thus, prognostic markers for CRLM are greatly needed. D-dimer, a fibrin cleavage product, has been shown to be related to colorectal tumor progression, and is also associated with malignant progression and recurrence in various cancers. Therefore, we evaluated the value of D-dimer in predicting the prognosis in CRLM.

METHODS

We retrospectively evaluated 90 cases of resected CRLM to determine the correlation between D-dimer and patient survival. The cut-off value for D-dimer levels was determined using receiver operating characteristic curve analysis.

RESULTS

Significant differences occurred in the recurrence group with higher D-dimer levels (P = 0.00736*), while the optimal cut-off value was 0.6 µg/mL. High D-dimer levels (≥ 0.6 µg/mL) were associated with poor recurrence-free survival (RFS; P = 0.0000841*) and cancer-specific survival (CSS; P = 0.00615*). In the multivariate analysis, D-dimer correlated with CRLM prognosis and independently predicted RFS (P = 0.0179*).

CONCLUSION

High D-dimer levels were associated with poor RFS and CSS. D-dimer was an independent prognostic factor of RFS. Therefore, D-dimer may help predict recurrence and prognosis in patients with CRLM.

Preoperative plasma fibrinogen, but not D-dimer might represent a prognostic factor in non-metastatic colorectal cancer: A prospective cohort study

BACKGROUNDS

Cancer progression has been associated with host hemostasis system. Whether preoperative plasma hemostasis factors can predict survival in colorectal cancer is quite intriguing.

METHODS

We conducted a prospective cohort study to validate the prognostic significance of three hemostasis parameters - fibrinogen, fibrin degradation products (FDPs) and D-dimer - in non-metastatic colorectal cancer patients treated with curative resection.

RESULTS

All three parameters were positively correlated with C reactive protein (CRP) levels and Glasgow Prognostic scores (GPS). In univariate cox hazards regression model, as continuous variables, both fibrinogen (HR: 1.07, 95%CI: 1.01-1.13) and FDPs (HR: 1.17, 95%CI: 1.05-1.31) were prognostic, while D-dimer levels were not. Patients with hyperfibrinogenemia had a 2.12-fold increased mortality risk compared with patients without hyperfibrinogenemia. Patients with positive FDPs had a 3.68-fold increased mortality risk compared with patients with negative FDPs. In multivariate models, hyperfibrinogenemia was prognostic (HR: 3.39, 95%CI: 1.34-8.67) in patients with normal GPS scores.

CONCLUSIONS

Preoperative fibrinogen levels appeared as an independent mortality risk factor in non-metastatic colorectal cancer patients with normal GPS scores. Fibrinogen could be a reliable marker to identify high risk patients for those without systematic inflammation responses.

Tissue factor expressed by microparticles is associated with mortality but not with thrombosis in cancer patients

A prothrombotic state is one of the hallmarks of malignancy and a major contributor to morbidity and mortality in cancer patients. Tissue factor (TF) is often overexpressed in malignancy and is a prime candidate in predicting the hypercoagulable state. Moreover, increased number of TF-exposing microparticles (MPs) in cancer patients may contribute to venous thromboembolism (VTE). We have conducted a prospective cohort study to determine whether elevated TF antigen, TF activity and TF associated to MPs (MPs-TF) are predictive of VTE and mortality in cancer patients. The studied population consisted of 252 cancer patients and 36 healthy controls. TF antigen and activity and MPs-TF were determined by ELISA and chromogenic assays. During a median follow-up of 10 months, 40 thrombotic events were recorded in 34 patients (13.5%), and 73 patients (28.9%) died. TF antigen and activity were significantly higher in patients than in controls (p<0.01) mainly in patients with advanced stages, whereas no differences were observed for TF activity of isolated MPs. We did not find a statistically significant association of TF variables with the risk of VTE. Multivariate analysis adjusting for age, sex, type of cancer and other confounding variables showed that TF activity (p<0.01) and MPs-TF activity (p<0.05) were independently associated with mortality. In conclusion, while TF variables were not associated with future VTE in cancer patients, we found a strong association of TF and MPs-TF activity with mortality, thus suggesting they might be good prognostic markers in cancer patients.

Fibrinogen and D-dimer levels elevate in advanced hepatocellular carcinoma: High pretreatment fibrinogen levels predict poor outcomes

AIM

Plasma fibrinogen and D-dimer have been reported to predict survival in several types of malignancies. The aim of this study is to investigate their predictive value in patients with hepatocellular carcinoma (HCC).

METHODS

We retrospectively analyzed plasma fibrinogen and D-dimer levels from 252 subjects: control (n = 20), hepatitis (n = 20), cirrhosis (n = 20), and HCC (n = 192) subjects. The clinical involvement and prognostic value of fibrinogen and D-dimer was analyzed in HCC subjects. To confirm the effects of tumor on hypercoagulability and fibrinolysis, fibrinogen and D-dimer levels were measured in nude mice following HCC inoculation.

RESULTS

Fibrinogen decreased and D-dimer increased in cirrhosis subjects relative to other groups. In HCC subjects, elevated fibrinogen and D-dimer levels were significantly associated with adverse tumor features (increased size, stage, and grade) and systemic inflammation. Patients with HCC with either elevated fibrinogen or D-dimer levels had significantly higher 3-year tumor recurrence rates (65% vs. 41%, P < 0.001 for fibrinogen; 67% vs. 40%, P = 0.011 for D-dimer) and significantly lower 3-year overall survival rates (57% vs. 79%, P < 0.001 for fibrinogen; 56% vs. 80%, P = 0.001 for D-dimer). After multivariate analysis, elevated fibrinogen levels remained an independent predictor of poor prognosis in HCC patients. Finally, elevated levels of fibrinogen and D-dimer were confirmed in nude mice following tumor inoculation.

CONCLUSION

The fibrinogen and D-dimer levels, elevating after carcinogenesis, may serve as simple but effective predictors of adverse tumor profiles and outcomes in HCC.

High pretreatment plasma D-dimer predicts poor survival of colorectal cancer: insight from a meta-analysis of observational studies

D-dimer, one of the canonical markers of hypercoagulability, was reported to be a potential prognostic marker of colorectal cancer. However, an inconsistent conclusion existed in several published studies. Thus, we performed this meta-analysis to provide a comprehensive insight into the prognostic role for pretreatment D-dimer in colorectal cancer. Six databases (English: Pubmed, Embase and Web of Science; Chinese: CNKI, Wangfang and VIP) were utilized for the literature retrieval. Hazard ratio (HR) was pooled by Stata 12.0. A total of fifteen studies (2283 cases) corresponded to this meta-analysis and provided available data to evaluate the prognostic role of D-dimer for colorectal cancer. The pooled HR reached 2.167 (95%. CI (confidence interval): 1.672-2.809, P < 0.001) utilizing random effect model due to obvious heterogeneity among the included studies (I²: 73.3%; P < 0.001). To explore the heterogeneity among the studies, we conducted a sensitivity analysis and found a heterogeneous study. After removing it, the heterogeneity reduced substantially (I²: 0%; P = 0.549) and we obtained a more convincing result by fixed effect model (HR = 2.143, 95% CI = 1.922-2.390, P < 0.001, 14 studies with 2179 cases). In summary, high pretreatment plasma D-dimer predicts poor survival of colorectal cancer based on the current evidence. Further prospective researches are necessary to confirm the role of D-dimer in colorectal cancer.

Nomogram predicted risk of peripherally inserted central catheter related thrombosis

The use of peripherally inserted central catheters (PICCs) is increasing rapidly worldwide. A number of patient-related, clinical-related and device-related characteristics might be risk factors for PICC-related thrombosis. We retrospectively reviewed a database of 320 consecutive patients who underwent PICC insertion between December 2014 and December 2015 at the First Affiliated Hospital of Xi’an Jiaotong University to explore the potential associations between risk factors and PICC-associated thrombosis. A novel nomogram for predicting risk was developed based on the data. The nomogram prediction model included ten risk factors that were derived from different relevant estimates. The nomogram prediction model showed good discriminatory power (Harrell’s C-index, 0.709) and a high degree of similarity to actual thrombosis occurring after calibration. Furthermore, principal component analysis was performed to identify the factors that most influence PICC-related thrombosis. Our novel nomogram thrombosis risk prediction model was accurate in predicting PICC-related thrombosis. Karnofsky performance scores, D-dimer and blood platelet levels and previous chemotherapy were principal components. Our findings might help clinicians predict thrombosis risk in individual patients, select proper therapeutic strategies and optimize the timing of anticoagulation therapy.

Prognostic role of Glasgow prognostic score in patients with colorectal cancer: evidence from population studies

Glasgow prognostic score (GPS) has been reported to be an indicator of prognosis for various cancers. However, the relationship between GPS and colorectal cancers (CRC) remains unclear. A comprehensive search of Pubmed, Embase, Cochrane library, Web of Science, ChinaInfo and Chinese National Knowledge Infrastructure was performed to identify eligible studies, from which the risk of overall survival (OS) and cancer-specific survival (CSS) were extracted. A random-effect model was adopted to combine hazard ratio (HR) and 95% confidence interval (CI). 25 articles with a total of 5660 participants were included. The pooled results indicated that elevated GPS was associated with poor OS (HR = 2.83, 95%CI: 2.00–4.00, P < 0.01) and CSS (HR = 1.94, 95%CI: 1.51–2.49, P < 0.01). This correlation was confirmed both in primary operable and advanced inoperable patients. Increased GPS was also closely related to advanced tumour-node-metastasis (TNM) stage (odds ratio [OR] = 1.44, 95% CI: 1.010–2.065, P < 0.05) and elevated level of serum carcinoembryonic antigen (OR = 2.252, 95% CI: 1.508–3.362, P < 0.01). Subgroup analysis revealed a significant association between high GPS and poor survival outcome according to the factors of sample size, study of region and cut-off value of GPS level. These findings suggest that GPS may serve as a reliable predictive index for patients with CRC.

Clinical significance of coagulation factors in operable colorectal cancer

Abnormal hemostasis in cancer patients has prev iously been studied. The primary objective of the present study was to evaluate the association between preoperative hemostasis markers and clinicopathological parameters, and to identify a hemostasis marker affecting survival in patients following curative resection for colorectal cancer. A total of 170 patients who underwent curative surgery for colorectal carcinoma were evaluated. Preoperative coagulation tests included platelet, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer and fibrinogen degradation product (FDP). The clinicopathological variables, including age, gender, tumor location (rectum/colon), tumor size (≥5 cm vs. <5 cm), depth of tumor invasion, lymph node metastasis, stage, lymphovascular invasion, margin involvement and histological differentiation were analyzed. The median age of analyzed patients was 63 years (range, 28-84). The male to female ratio was 62:38. Increased levels of plasma fibrinogen, PT and platelet count (PLT) were associated with larger tumor size (P<0.001, P=0.015 and P=0.002, respectively). Increased plasma fibrinogen levels were significantly associated with depth of tumor invasion and stage (P=0.014 and P=0.048, respectively). Increased plasma D-dimer and FDP levels were significantly associated with tumor node metastasis stage (P=0.031 and P=0.002, respectively). Prolonged PT level (≥11.7 sec), hyper-fibrinogenemia (≥327 mg/dl), high D-dimer level (≥1.3 µg/ml) and increased FDP level (≥2.7 µg/ml) were the prognostic factors associated with shorter survival. Preoperative plasma fibrinogen level was significantly associated with tumor size and depth of tumor invasion. Preoperative plasma prolonged PT level, hyperfibrinogenemia, high D-dimer level and increased FDP level may function as hemostasis markers that predict overall survival in operable patients with colorectal cancer.

Monoclonal antibodies with equal specificity to D-dimer and high-molecular-weight fibrin degradation products

Fibrin degradation results in the formation of fibrin degradation products (FDPs) of different molecular weights, which include D-dimer. Commercial D-dimer assays recognize multiple forms of FDP with different specificity. As a result, the absence of an international D-dimer standard and the marked discrepancy in the D-dimer values in the same samples measured by assays from different manufacturers have become the primary problems that clinicians face in the D-dimer determination. We consider that an assay with equal specificity to all FDP forms regardless of their molecular weights could help to solve these problems. We aimed to produce mAbs that could equally recognize high-molecular-weight FDP (HMW FDP) and D-dimer. mAbs against D-dimer were produced. The HMW FDP/D-dimer ratios in plasma samples were analyzed following protein separation by gel filtration using the developed fluoroimmunoassay. A sandwich immunoassay with equal specificity to HMW FDP and D-dimer was developed and applied to determine HMW FDP/D-dimer ratios in patients with different diseases. Although the HMW FDP levels prevailed in thrombotic patients, the FDP and D-dimer levels were comparable in septic patients. Meanwhile, the D-dimer levels often exceeded the HMW FDP levels in patients who had undergone surgery. The 'D-dimer' levels that were detected by different assays also varied greatly depending on the assay specificities to FDP and D-dimer. Our findings show that the introduction of assays with equal specificities to FDP and D-dimer in clinical practice is a possible way of standardizing D-dimer measurements.

The Prognostic Value of D-Dimer in De Novo Acute Myeloid Leukemia

BACKGROUND

The aim of this study was to evaluate the prognostic value of D-dimer in patients with newly diagnosed de novo non-M3 subtypes of acute myeloid leukemia (AML).

MATERIALS AND METHODS

We retrospectively analyzed the clinical data from 245 patients with newly diagnosed de novo non-M3 subtypes of AML at the Tongji Hospital from January 2010 to December 2014.

RESULTS

The comparison results indicated that the D-dimer values were higher in patients with AML with the following characteristics: WBC count ≥ 20 × 10(9)/L (2.20 versus 6.00, P = 0.001), percentage of bone marrow (BM) blasts ≥ 60% (2.06 versus 5.69, P = 0.003), and poor-risk stratification (P < 0.001). Cox univariate regression analysis showed that overall survival was negatively affected by the following factors: age > 60 years, poor-risk stratification, BM blast cell count ≥60%, and D-dimer ≥1μg/mL. Multivariate analysis showed that only age > 60 years (P < 0.001), BM blast cell counts ≥60% (P = 0.001) and D-dimer values ≥1μg/mL (P = 0.014) were independent adverse prognostic factors.

CONCLUSIONS

D-dimer ≥1μg/mL is related to high tumor burden and can be considered as an independent prognostic factor in patients with de novo non-M3 AML.

High Pretreatment D-Dimer Levels Correlate with Adverse Clinical Features and Predict Poor Survival in Patients with Natural Killer/T-Cell Lymphoma

Pretreatment plasma D-dimer levels have been reported to predict survival in several types of malignancies. The aim of this study was to evaluate the prognostic value of D-dimer levels in patients with newly diagnosed natural killer/T-cell lymphoma (NKTCL). The cut-off value of D-dimer to predict survival was set as 1.2 μg/mL based on the receiver operating curve analysis. Patients with a D-dimer level ≥ 1.2 μg/mL had significantly more adverse clinical features, including poor performance status, advanced stage diseases, B symptoms, elevated serum lactic dehydrogenase levels, involvement of regional lymph nodes, more extranodal diseases, and higher International Prognostic Index and natural killer/T-cell lymphoma prognostic index scores. A D-dimer level ≥ 1.2 μg/mL was significantly associated with inferior 3-year overall survival (OS, 13.0 vs. 68.5%, P < 0.001). In the multivariate analysis, a D-dimer level ≥ 1.2 μg/mL remained an independent predictor for worse OS (HR: 3.13, 95% CI: 1.47-6.68, P = 0.003) after adjusting for other confounding prognostic factors. Among patients with Ann Arbor stage I-II diseases, those with a D-dimer level ≥ 1.2 μg/mL had a significantly worse survival than those with a D-dimer level < 1.2 μg/mL (3 year-OS: 76.2 vs. 22.2%, P < 0.001). Survival of early-stage patients with a high D-dimer level was similar to that of the advanced-stage patients. In conclusion, pretreatment plasma D-dimer level may serve as a simple but effective predictor of prognosis in patients with NKTCL.

Widely Used Types and Clinical Applications of D-Dimer Assay

D-dimers are formed by the breakdown of fibrinogen and fibrin during fibrinolysis. D-dimer analysis is critical for the diagnosis of deep vein thrombosis, pulmonary embolism, and disseminated intravascular coagulation. Modern assays for D-dimer are monoclonal antibody based. The enzyme-linked immunosorbent assay (ELISA) is the reference method for D-dimer analysis in the central clinical laboratory, but is time consuming to perform. Recently, a number of rapid, point-of-care D-dimer assays have been developed for acute care settings that utilize a variety of methodologies. In view of the diversity of D-dimer assays used in central laboratory and point-of-care settings, several caveats must be taken to assure the proper interpretation and clinical application of the results. These include consideration of preanalytical variables and interfering substances, as well as patient drug therapy and underlying disease. D-dimer assays should also be validated in clinical studies, have established cut-off values, and reported according to the reagent manufacturers recommendations.

Elevated D-dimer and fibrinogen levels in serum of preoperative bone fracture patients

The changes of coagulation parameters in preoperative fracture patients reflect the coagulation status before surgery. We did retrospective assessment of preoperative fracture patients (n = 113) admitted to the hospital between September 2013 and September 2014. The control group were selected from healthy adults (n = 113) with matched age and gender. Platelet, PT INR, APTT, fibrinogen (FIB) and D-dimer values were collected and analyzed. PT INR level was 1.043 ± 0.119, APTT was 31.91 ± 7.56 s, FIB was 320.6 ± 71.8 mg/dl and D-dimer was 1283 ± 1582 ng/ml for the fracture patients. For the control group, PT INR level was 0.9976 ± 0.0602, APTT was 33.22 ± 2.55 s, FIB was 277.3 ± 44.7 mg/dl and D-dimer was 97.53 ± 63.90 ng/ml. Meanwhile, D-dimer levels of different sites of fractures were also measured: Femora 2448 ± 1961 ng/ml; Humerus 792.4 ± 691.2 ng/ml; Ulna/Radius 619.4 ± 843.7 ng/ml; Vertebra 647.7 ± 787.1 ng/ml; Tibia/Fibula 496.3 ± 268.8 ng/ml; Clavicle 260.9 ± 170.9 ng/ml; Ankle 415.4 ± 286.6 ng/ml. To conclude, D-dimer and fibrinogen levels get higher in preoperative fracture patients than controls. Besides, D-dimer levels are significantly different among different locations of fractures, and our data revealed that D-dimer levels of Femora fracture were higher than other sites.

Preoperative D-dimers as an independent prognostic marker in cervical carcinoma

Activation of coagulation and fibrinolysis has been observed in many tumors. Our study aimed to investigate the clinical and prognostic significance of various plasma coagulation tests in patients with cervical cancer. A total of 296 patients with cervical cancer were included in the analysis. Patients were followed up for at least 60 months until death. Pretreatment parameters including activated partial thromboplastin time, D-dimer, fibrinogen, prothrombin time, thrombin time, lactate dehydrogenase, and squamous cell carcinoma antigen were evaluated. Prothrombin time (hazard ratio = 1.825; P = 0.006) and plasma D-dimer levels (hazard ratio = 2.179; P = 0.036) were identified as significant independent predictors of overall survival. Patients with elevated D-dimer levels had a significantly shorter overall survival compared with those with low-D-dimer levels (<0.5 μg/ml) in the stage I subgroup (n = 98, P = 0.019) and stage II subgroup (n = 77, P = 0.044). D-dimer levels differed significantly according to mortality (P < 0.001), stage I versus stage II (P = 0.030), and stage I versus stage III/IV (P = 0.038). DD level of patients with chemotherapy and/or radiotherapy was higher than patients with other treatment (P < 0.001). Patients with a low-D-dimer level (<0.5 μg/ml) showed a significantly better 5-year overall survival (OS) compared with patients with an increased D-dimer level for different histological typing of squamous cell carcinoma (SCC) (P = 0.001) and non-SCC (P < 0.043). In conclusion, the pretreatment plasma D-dimer level is a potential prognostic factor for cervical cancer.

High plasma fibrinogen is correlated with poor response to trastuzumab treatment in HER2 positive breast cancer

Some of HER-2 positive breast cancer patients failed to trastuzumab treatment. Recent reports have indicated the correlation between plasma coagulation parameters and clinical characteristics in breast cancer. The aim of this study was to analyze the role of coagulation parameters in trastuzumab treated patients. Coagulation parameters from trastuzumab treated breast cancer patients were retrospectively studied from 2006 to 2010. The correlation between routine coagulation levels and clinical characteristics were analyzed, including prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fib) and D-dimer (DD). The Kaplan-Meier analysis and Cox regression hazard model were applied to assess their effect on prognosis. Totally 102 hospitalized breast cancer patients who received trastuzumab were collected and followed-up. All patients were HER-2 positive advanced breast cancer, with a median age of 45 years old. Extended PT, APTT, and TT were found in trastuzumab treatment non-effective group, as well as increased Fib and DD. But significant increase was only found in Fib. High Fib status (Fib > 2.88 g/L) was correlated with clinical characteristics, such as pathological grade, and reversely correlated with PTEN expression. More importantly, poor disease-free survival (DFS) and overall survival (OS) to trastuzumab treatment were found in high Fib breast cancer patients. This retrospective study suggests high Fib status was correlated with poor treatment response to trastuzumab. Our findings indicated that Fib > 2.88 should alert physicians to consider a pretreatment for reducing Fib levels before trastuzumab treatment in HER-2 positive breast cancer patients.

Systemic inflammation, as measured by the neutrophil/lymphocyte ratio, may have differential prognostic impact before and during treatment with fluorouracil, irinotecan and bevacizumab in metastatic colorectal cancer patients

The inflammatory index neutrophil/lymphocyte ratio (NLR) has an adverse prognostic value in patients with localized colorectal cancer (CRC). We aimed at evaluating its role in metastatic CRC (mCRC) patients treated with standard first-line chemotherapy. Among consecutive CRC patients referred to our Unit, those with metastatic disease eligible for treatment with fluorouracil, irinotecan and bevacizumab (FOLFIRI-Bev) were included in the study. NLR was routinely assessed before each treatment cycle and correlated with outcome together with common clinical, biochemical and histological variables. A sub-analysis focused on patients with stable disease (SD) was also performed to test the net influence of NLR changes independently of tumor shrinkage. At multivariate Cox regression analysis, baseline NLR, taken as continuous variable, was the most powerful prognosticator for survival (HR 1.80, p 0.0019). Surprisingly, among SD patients, the prognostic effect of NLR changes after two cycles of therapy was of opposite sign, and those in whom NLR increased or was maintained had a 67 % reduction in the risk of death as compared with patients with significant NLR decrease: mOS 56 versus 23 months, respectively, p 0.02. In conclusion, we were able to confirm the adverse prognostic value of high baseline NLR for mCRC patients treated with FOLFIRI-Bev. However, FOLFIRI-Bev-induced NLR changes in SD patients seem to differently affect survival. The specific molecular pathways involved in NLR modulation by FOLFIRI-Bev warrant further investigation.

D-dimer: not just an indicator of venous thrombosis but a predictor of asymptomatic hematogenous metastasis in gastric cancer patients

Background

Plasma D-dimer levels have been shown to be high in advanced tumor stage patients and can be used to predict clinical outcome in cancer patients. As most advanced tumor stage patients exhibit asymptomatic metastasis, which contributes to early tumor recurrence after surgery, we hypothesized that plasma D-dimer levels can be used to predict patients with potential metastasis.

Methods

We enrolled 1042 primary gastric cancer patients in three multiple cancer centers in Northwest China and examined plasma D-dimer levels using the latex-enhanced immunoturbidimetric assay (LEIA) method. Plasma D-dimer levels were compared with the clinicopathological characteristics in this large-scale case-control study with follow up. We also performed regular follow-up studies for 395 patients to analyze the 2-year survival rate and early tumor recurrence.

Results

In this large-scale clinical study, we found that plasma D-dimer levels were increased in patients with distant metastasis and especially hematogenous metastasis patients. The cut-off value of the D-dimer levels was determined to be 1.5 mg/ml based on the ROC curve, and the sensitivity and specificity for metastasis prediction were 61.9% and 86.6%, respectively. Additionally, patients with high D-dimer levels displayed early tumor recurrence and poor outcome during the follow-up study.

Conclusion

Plasma D-dimer may represent an easy to measure and lower cost marker for the testing of gastric cancer patients to predict asymptomatic hematogenous metastasis.