D-dimer levels and prediction of overall survival in cancer patients.

Abstract

10587 Background: Procoagulant changes in the haemostatic system and activation of haemostasis are frequently observed in cancer patients, even in the absence of venous thromboembolism (VTE). Moreover, coagulation activation has been implicated in tumour progression, invasion, angiogenesis and metastatic spread. D-dimer is produced when cross-linked fibrin is degraded by plasmin and reflects the activation of coagulation and fibrinolysis. Recently, high D-dimer levels were reported to predict the occurrence of VTE in cancer patients. Our aim was to assess the prognostic value of D-dimer levels in cancer patients included in the ongoing prospective observational Vienna Cancer and Thrombosis Study (CATS), which was initiated in 2003 to identify predictive parameters for cancer-associated VTE. Methods: The CATS includes patients with newly diagnosed cancer or progression of disease after remission. Patients are followed over 2 years at regular intervals until occurrence of symptomatic VTE or death. D-dimer levels were measured with a D-Dimer latex agglutination assay. Kaplan-Meier and Cox regression analyses were applied for statistical calculation. Results: Data from 873 patients with solid tumours or haematological malignancies (394 female/479 male, median age [IQR]: 62 [53-68] yrs) were available for survival analyses. Main tumor entities were malignancies of the breast (n = 139), lung (n = 126), stomach (n = 36), lower gastrointestinal tract (n = 114), pancreas (n = 48), kidney (n = 24), prostate (n = 113), and brain (n = 109); 116 had hematologic malignancies; 48 had other tumors. Patients were followed for a median observation time of 731 days and 357 (40.1%) patients died during follow-up. The probabilities of overall survival for patients with D-Dimer levels at study inclusion in the first, second, third and fourth quartile were 88%, 82%, 66% and 53% after 1 year and 80%, 66%, 50% and 30% after 2 years, respectively (p < 0.001). The hazard ratio (HR) of D- dimer for mortality was 1.5 (95% CI: 1.4-1.6, p < 0.001) per double increase of D-dimer and remained similarly increased in multivariable analysis which included age, sex and metastatic spread. Conclusions: High levels of D-dimer independently predict mortality risk in cancer patients. No significant financial relationships to disclose.