Abstract
BackgroundPlasma 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.MethodsWe 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.ResultsIn 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.ConclusionPlasma D-dimer may represent an easy to measure and lower cost marker for the testing of gastric cancer patients to predict asymptomatic hematogenous metastasis.
Highlights
Hematogenous metastasis means blood borne metastasis is the most critical complication of malignancy; our understanding of this phenomenon remains incomplete [1]
We performed a follow-up study with a subset of the Gastric cancer (GC) patients to estimate overall survival (OS) and early tumor recurrence (ETR, recurrence within 2 years) based on high and low D-dimer levels based on the Receiver operator characteristic (ROC) curve
The cut-off values for 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
Summary
Hematogenous metastasis means blood borne metastasis is the most critical complication of malignancy; our understanding of this phenomenon remains incomplete [1]. It has been suggested that the formation of platelet-fibrin-tumor cell aggregates may play a causal role in endothelial adhesion and metastatic potential [4]. Deposition of fibrin within adherent tumor cell-platelet aggregates can be detected as early as 5 minutes after tumor cell inoculation and persists for more than 9 hours [5]. Plasma D-dimer may be involved in the promotion of a metastatic phenotype in the bloodstream. 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
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