Abstract
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.
Highlights
Extranodal natural killer/T-cell lymphoma (NKTCL) is a relatively rare and unique subtype of lymphoid malignancy [1]
The optimal cut-off value of D-dimer to predict survival was 1.2 μg/mL based on the receiver operating curve (ROC) analysis (Fig 1)
Results showed that: (1) high levels of pretreatment D-dimer were associated with significantly more adverse clinical characteristics, including poor performance status, advanced diseases, elevated lactic dehydrogenase (LDH) levels, and higher International Prognostic Index (IPI) and natural killer/Tcell lymphoma prognostic index (NKPI) scores, etc; (2) high levels of D-dimer were associated with substantially worse survival and remained an independent adverse prognostic factor in the multivariate analysis; (3) high levels of D-dimer could indentify high-risk individuals with significantly poor survival from those with early-stage disease
Summary
Extranodal natural killer/T-cell lymphoma (NKTCL) is a relatively rare and unique subtype of lymphoid malignancy [1]. This disease shows an invasive biological behavior characterized by its destructive and ulcerative lesions (mostly in the nasal cavity), rapid clinical progression, and dismal outcomes. Extensive necrosis and inflammatory infiltrates are frequently observed in lesions under microscope and fever is a common clinical manifestation among the patients, indicating a strong association between NKTCL and inflammatory reactions [2,3]. Heterogeneous treatment response and prognosis have been observed in NKTCL. The International Prognostic Index (IPI) and natural killer/Tcell lymphoma prognostic index (NKPI) are the most commonly used models for prognostic stratification in NKTCL, but their accuracy remains controversial [11,12,13]. It is important to explore more simple and accurate prognostic factors for risk stratification before treatment
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call