Prognostic Significance of Preoperative Plasma D-Dimer Level and Clinical Factors in Patients with Spinal Giant Cell Tumor: Retrospective Analysis of 153 Patients in a Single Center

Abstract

Giant cell tumor (GCT) of the spine is a benign tumor with local aggressiveness and potential for recurrence. No published study has discussed the prognostic role of preoperative D-dimer (D-D) level in spinal GCT. The purpose of this retrospective study was to evaluate the prognostic value of preoperative plasma D-D level and clinical factors. Routine clinical parameters and plasma D-D level were analyzed preoperatively. The disease-free survival (DFS) rate was estimated using Kaplan-Meier analysis. Variables with P value <0.1 were subjected to multivariate analysis by Cox regression analysis. P values <0.05 were considered statistically significant. The recurrence rate of spinal GCT was 21.6% in our series. A total of 153 patients were stratified into 2 groups by preoperative D-D level of ≤0.5 μg/mL or >0.5 μg/mL. We found that several clinicopathologic features were associated with the D-D level, including tumor location, the segment involved, Jaffe grade, and recurrence (P < 0.05). Multivariate analysis indicated that the treatment history, resection mode, bisphosphonate treatment, and preoperative D-D level were prognostic factors of DFS (all P < 0.05). In addition, the Jaffe grading system stratified by preoperative plasma D-D level was correlated with DFS of patients with spinal GCT (P < 0.05). Our study demonstrated that preoperative plasma D-D level, total spondylectomy, bisphosphonate treatment, and treatment history were powerful independent prognostic factors for DFS of patients with spinal GCT, suggesting that preoperative plasma D-D level may be a useful biomarker for predicting recurrence and prognosis of spinal GCT.