Abstract
The aim of this study was to investigate the relationship between plasma D-dimer levels and its perioperative change and clinicopathological parameters in patients with operable esophageal squamous cell carcinoma (ESCC). We also analyzed their prognostic significance in ESCC patients. The data of 294 ESCC patients between December 2007 and December 2012 in Mingzhou hospital, Ningbo, China were analyzed retrospectively. Plasma D-dimer levels were measured one week before surgery and on the thirtieth postoperative day. The association between plasma D-dimer levels and clinicopathological parameters was evaluated. Kaplan-Meier survival analysis and Cox proportional hazards models were used to estimate the effect of plasma D-dimer levels and its perioperative change on disease-free survival (DFS) and overall survival (OS). Plasma D-dimer levels were above 0.5 µg/mL in 148 patients (50.3%). Plasma D-dimer levels were significantly related with DFS (P < 0.001) and OS (P < 0.001) in univariate analysis. There was significant relationship between plasma D-dimer levels and DFS in patients with N0 (P < 0.001) or N+ (P = 0.003). Multivariate analysis revealed that plasma D-dimer levels (P < 0.001), sex (P = 0.012), and T stage (P = 0.033) were independent prognostic factors for DFS. Tumor length (P = 0.018), T stage (P = 0.008) and plasma D-dimer levels (P = 0.001) qualified as independent prognostic factors for OS. Our study suggests that pretreatment plasma D-dimer levels is a powerful independent prognostic factor for operable ESCC. Further studies are needed to prospectively validate this prognostic model and investigate the mechanisms underlying the correlation between elevated plasma D-dimer levels and poor prognosis in operable ESCC.
Highlights
Esophageal cancer is the sixth leading cause of cancer-related mortality in both developing and developed countries [1]
Our study suggests that pretreatment plasma D-dimer levels is a powerful independent prognostic factor for operable esophageal squamous cell carcinoma (ESCC)
In a large scale of 1042 gastric patients, plasma D-dimer levels were significantly elevated in metastasis GC patients, especially in patients with hematogenous visceral metastasis, and plasma D-dimer levels correlated with vascular cancer emboli in resected tissue samples [18]
Summary
Esophageal cancer is the sixth leading cause of cancer-related mortality in both developing and developed countries [1]. Esophageal squamous cell carcinoma (ESCC) is the most prevalent type of esophageal cancer, in East Asia and some parts of Europe [2]. Despite recently much more effort has been dedicated to improving treatment of patients suffering from ESCC, the prognosis remains quite poor, with a great number of patients experiencing disease progression in a short time [3]. The 5-year survival rates for surgically resectable ESCC are still unsatisfactory and range from 15% to 30% [4,5,6]. Adjuvant chemotherapy or radiotherapy could improve disease-free survival [7]. The benefit of platinum-based adjuvant chemotherapy for ESCC patients has not been established. Several studies have attempted to discover molecular biomarkers to predict the prognosis of ESCC [8,9,10]. To date, most of these markers had not been proven to be sufficiently effective [11]
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