Abstract
High pre-treatment plasma D-dimer levels have been reported as a factor associated with a poor prognosis in different types of malignancies, including pancreatic, gastric, colorectal, lung, and nasopharyngeal carcinoma. Here, we performed a meta-analysis to determine the association of plasma D-dimer levels and long term survival in gynecological cancers, including ovarian, cervical and endometrial carcinoma. We searched all eligible publications in PubMed and Web of Science Databases up to August 2016. Primary outcomes, including overall survival (OS), disease-free survival and hazard ratios (HR) of were extracted and analyzed. Heterogeneity and publication bias were also assessed. A total of 7 eligible studies with 1112 cases were included in this study and all included studies are conducted in East Asia area. We found that gynecological cancer patients with high D-dimer demonstrates a much lower 5-year survival rate than those with low D-dimer levels (OR 4.12, 95% CI 3.04-5.58, P<0.00001). No significant heterogeneity is found (I2 = 10 %; P = 0.35). Importantly, pooled analysis showed that high plasma D-dimer levels are predictive of a shorter OS in gynecological cancers (HR 2.09, 95% CI 1.59-2.74). No heterogeneity is observed (I2=5%, P=0.39). Additionally, a subgroup analysis of ovarian cancer is conducted. In conclusion, this meta-analysis showed that a high plasma D-dimer level predicts poor prognosis in gynecological tumors.
Highlights
Gynecological cancers, including ovarian, endometrial and cervical cancers, are major types of malignancies of genital system for women worldwide
We found that gynecological cancer patients with high D-dimer demonstrates a much lower 5-year survival rate than those with low D-dimer levels
A large prospective study from the Vienna Cancer and Thrombosis study with 1178 cancer patients indicates that D-dimer associated with poor survival in solid cancer patients [18]
Summary
Gynecological cancers, including ovarian, endometrial and cervical cancers, are major types of malignancies of genital system for women worldwide. In the United States, 95000 women are estimated to be diagnosed with gynecological cancers and 28800 will die of it in 2016 [1]. According to the GLOBOCAN database, the incidence and mortality of gynecological cancers are lower in East Asia than North America area. There are about 750,000 new gynecological carcinoma cases worldwide and about 150,000 of them are from East Asia in 2012(20%). Targeted therapeutics, such as EGFR inhibitors and other Serine/Threonine kinase inhibitors have shown limited efficacy in gynecological cancers and current therapies remain to be radical surgical tumor debulking plus platinum-based chemotherapy [2]. Effective prognostic biomarkers are in great need www.impactjournals.com/oncotarget to distinguish gynecological cancer patients who require more aggressive treatments
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