Abstract
D-dimer levels are reported to relate with tumor stage, prognosis, and lymph node involvement, as well as overall survival (OS) in patients with solid tumors. The purpose of this study was to investigate association between the value of D-dimer and the prognosis of oral cancer (OC). We designed a retrospective cohort study and enrolled a sample of patients who were diagnosed with OC and treated with surgery and/or radiotherapy. The predictor was the D-dimer and outcome variable was OS. Other variables included age, neutrocyte count, neutrophil lymphocyte ratio (NLR), C-reactive protein (CRP), and management. Differences in OS rate were analyzed by log-rank test. A Cox proportional hazards model was used to adjust for the effects of potential confounders. Differences with a P value less than 0.05 were considered statistically significant. In 88 patients with OC, D-dimer median value for the predicting OS was 0.7 µg/mL. There was a significant difference in OS when patients were stratified according to D-dimer, with an OS rate of 77.8% for patients with low D-dimer (<0.7), and 57.3% with high D-dimer (≥0.7) (p = 0.035). Univariate analyses revealed close correlations between OS and age, neutrocyte count, NLR, CRP, and D-dimer (<0.7 and ≥0.7). Cox multivariate analysis identified management (mainly surgery vs. radiotherapy) (HR 3.274, 95% CI 1.397–7.676; p = 0.006) as independent predictive factors for OS. There was a significant difference in OS when patients were stratified according to D-dimer with low (<0.7) and high D-dimer (≥0.7) (p = 0.035). Though, as a predictive factor, management was associated with OS.
Highlights
D-dimer is a stable end product of the degradation of cross-linked fibrin, which results from enhanced fibrin formation and fibrinolysis
As a predictive factor, management was associated with overall survival (OS)
Serum D-dimer concentration was evaluated pretreatment and during treatment, while venous ultrasonography (US) of the lower extremities was performed by an experienced sonographer to establish the incidence and location of deep vein thrombosis (DVT) for the patients D-dimer > 1.0 μg/mL according to rules of our hospital
Summary
D-dimer is a stable end product of the degradation of cross-linked fibrin, which results from enhanced fibrin formation and fibrinolysis. It has been reported that increases in D-dimer levels have a correlation between malignant diseases. Some studies report that D-dimer levels are related to tumor stage, tumor prognosis, and lymph node metastasis, as well as overall survival (OS) in patients with lung cancer, breast cancer, gastric cancer, colon cancer, and gynecological cancer. Elevated D-dimer levels may influence multifactorial interactions between carcinoma growth and the hemostatic fibrinolytic system in malignancy [1,2,3,4]. The 8th edition of the American Joint Committee on Cancer (AJCC) staging in oral squamous cell carcinoma (OSCC) was published and two new parameters, namely depth of invasion (DOI) and extranodal extension (ENE), were included. The use of ENE in pN classification was reported as identifying patients with a worse prognosis. The use of lymph node ratio (LNR) improve
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