The D-dimer level predicts the postoperative prognosis in patients with non-small cell lung cancer.

Yuki Shiina,Yuichi Sakairi,Hidemi Suzuki,Takahiro Nakajima,Ichiro Yoshino,Hironobu Wada,Takayoshi Yamamoto,Kazuhisa Tanaka,Masaru Katoh

doi:10.1371/journal.pone.0222050

Yuki Shiina, Yuichi Sakairi + Show 7 more

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https://doi.org/10.1371/journal.pone.0222050

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Journal: PloS one	Publication Date: Dec 26, 2019
Citations: 24	License type: CC BY 4.0

Affiliation: Chiba University

Abstract

Carcinoma cells often modulate coagulation and fibrinolysis among cancer patients. Plasma dimerized plasmin fragment D (D-dimer) has been reported as a prognostic marker of various types of malignancies, including non-small cell lung cancer (NSCLC). However, the associations between the plasma D-dimer level and peripheral small NSCLC remain unclear. Three hundred and sixty-two patients with NSCLC who underwent radical surgery were retrospectively reviewed. Patients who received anticoagulation therapy before surgery or who lacked preoperative D-dimer data were excluded. The other 235 patients were divided into a high D-dimer (over 1.0 μg/mL) group (HDD group, n = 47) and a normal D-dimer group (NDD group, n = 188) and investigated for their clinical characteristics, computed tomography (CT) findings, pathological findings, and clinical outcomes. The mean D-dimer levels was 2.49±2.58 μg/ml in the HDD group and 0.42±0.23 μg/ml in the NDD group. The HDD group was characterized by a predominance of male gender, older age, pure solid appearance on chest CT, vascular invasion in pathology, and a large solid part of the tumor. The HDD group showed a worse overall survival, disease-free survival, and disease-specific survival than the NDD group (p<0.001, <0.001, <0.001, respectively). These survival features were also observed in p-Stage IA disease. There was no marked survival difference when tumors showed ground-glass opacity on CT. In NSCLC patients with a solid tumor appearance on CT, high D-dimer levels predict a poor survival and early recurrence.

Highlights

Carcinoma cells often affect coagulation and fibrinolysis in cancer patients due to their inducing cytokines and coagulation factors
The HDD group was characterized by a predominance of male gender, older age, pure solid appearance on chest computed tomography (CT), vascular invasion in pathology, and a large solid part of the tumor
The HDD group was characterized by a predominance of male gender, older age, pure solid appearance on chest CT, a large solid part of the tumor, advanced c-T factor, advanced c-N factor and advanced c-staging compared with the NDD group (Table 1)

Summary

Introduction

Carcinoma cells often affect coagulation and fibrinolysis in cancer patients due to their inducing cytokines and coagulation factors. Several previous studies have reported that, in operable non-small cell lung cancer (NSCLC) patients, the D-dimer levels predict the risk of postoperative early recurrence and a poor prognosis [2, 3]. Hattori et al showed that patients with tumors showing a ground-glass appearance on CT had a better prognosis than those with tumors with a pure solid appearance [6]. Such a radiologic feature is very important when considering surgical management for peripheral small NSCLC, i.e. whether to perform limited resection or conventional lobectomy. Plasma dimerized plasmin fragment D (D-dimer) has been reported as a prognostic marker of various types of malignancies, including non-small cell lung cancer (NSCLC). The associations between the plasma D-dimer level and peripheral small NSCLC remain unclear

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