Pretreatment Plasma D-dimer Levels Research Articles

Prognostic Significance of Pretreatment Plasma D-dimer Levels in EGFR-Positive Advanced Non-Small Cell Lung Cancer Patients Receiving Osimertinib: A Multicentre Retrospective Study.

This study examined the association between plasma D-dimer levels and overall survival (OS) in advanced non-small cell lung cancer (NSCLC) patients treated with osimertinib. In this multicenter study, 88 patients with advanced non-small cell lung cancer (NSCLC) carrying epidermal growth factor receptor (EGFR) mutations and receiving osimertinib were enrolled. The target independent and dependent variables were the D-dimer levels before osimertinib treatment and OS time, respectively. The t-test or chi-square test was utilized to analyze the variances among various groups. The predictive significance of D-dimer for overall survival (OS) was assessed using Kaplan-Meier survival analysis and the Cox proportional hazard regression model. The selected patients had an average age of 58.01±10.72 years, with females comprising 54.55%. Based on their D-dimer levels, the patients were categorized into three groups: low-level (< 0.6 mg/L), middle-level (0.6 ~ 2 mg/L), and high-level (≥ 2 mg/L). After accounting for possible confounding variables, the Cox proportional hazard model showed that increased D-dimer levels were linked to a greater likelihood of death (HR 2.28, 95% CI = 1.09 ~ 4.76, p = 0.029). Importantly, there was a significant trend indicating that as D-dimer levels rose, the risk of mortality also increased (p for trend, HR 1.15, 95% CI = 1.03 ~ 1.28, p = 0.012). Consistently comparable outcomes were noted in the majority of subcategories. Patients with low-middle and high D dimer levels had a median OS of 28.6 and 17 months, respectively (p =0.014). In conclusion, elevated levels of D-dimer in the bloodstream were found to have a significant negative correlation with the overall survival (OS) of patients with EGFR-positive non-small cell lung cancer (NSCLC) who underwent treatment with osimertinib.

Post-Treatment Plasma D-Dimer Levels Are Associated With Short-Term Outcomes in Patients With Cancer-Associated Stroke.

Background and ObjectiveHypercoagulability is associated with increased risks of ischemic stroke and subsequent mortality in patients with active cancer. This study investigated the relationships between plasma D-dimer levels after stroke treatment and short-term outcomes in patients with cancer-associated stroke.MethodsThis retrospective, observational, multicenter study analyzed consecutive patients with cancer-associated ischemic stroke. Hypercoagulability was assessed by plasma D-dimer levels before and after stroke treatment. Short-term outcomes were assessed in terms of poor outcomes (a modified Rankin Scale score >3), cumulative rates of recurrent ischemic stroke, and mortality at 30 days after admission.ResultsOf 282 patients, 135 (47.9%) showed poor outcomes. Recurrent ischemic stroke was observed in 28 patients (9.9%), and the cumulative mortality rate was 12.4%. Multivariate analysis showed that post-treatment plasma D-dimer levels ≥10 μg/ml were independently associated with both poor outcomes (adjusted odds ratio [OR], 9.61; 95% confidence interval [CI], 3.60–25.70; P < 0.001) and mortality (adjusted OR, 9.38; 95% CI, 3.32–26.44; P < 0.001). Pre-treatment plasma D-dimer levels ≥10 μg/ml were not associated with these outcomes. Patients who received heparin had higher pre-treatment plasma D-dimer levels than those treated with other anticoagulants. Heparin produced a significant reduction in D-dimer levels from pre- to post-treatment without increasing the incidence of hemorrhagic events.ConclusionA high plasma D-dimer level after stroke treatment was associated with poor short-term outcomes in patients with cancer-associated stroke. Using anticoagulants to reduce D-dimer levels may improve short-term outcomes in these patients.

D-Dimer: A Potential Solution to Problems of Cancer Screening, Surveillance, and Prognosis Assessment.

Research has established a direct link between the plasma level of D-dimer and underlying malignancy. D-dimer has a strong association with the detection and prognosis of several cancers. For these reasons, this literature review aimed to evaluate the usefulness of elevated D-dimer levels in the initial screening of cancer, cancer recurrence surveillance, and for use as a cancer prognostic tool. A search of PubMed up to February 1, 2021, was carried out by reviewers. This literature review includes studies investigating the relationship between pretreatment plasma D-dimer levels and cancer. From the findings, pretreatment D-dimer levels can assist with cancer screening and prognosis assessment. Pretreatment plasma D-dimer levels can function as an effective cancer recurrence control. Elevated pre-treatment plasma D-dimer concentration is valuable in facilitating cancer screening, predicting an augmented risk of cancer recurrence, and anticipating a worse cancer prognosis.

High pretreatment plasma D-dimer levels predict poor survival in patients with diffuse large B-cell lymphoma in the real world.

BackgroundData on the role of pretreatment plasma D-dimer levels in the prognostic prediction of patients with diffuse large B-cell lymphoma (DLBCL) are limited. We here studied the potential prognostic roles of pretreatment plasma D-dimer levels in patients with DLBCL.MethodsWe retrospectively analyzed medical records of 308 newly diagnosed patients with DLBCL admitted to the Fujian Medical University Union Hospital between January 2011 and December 2018. Receiver operating characteristic (ROC) curve analysis were used to generate an optimal cut-off value for pretreatment plasma D-dimer levels in patients with DLBCL. According to the cut-off value, all patients were divided into the low D-dimer and high D-dimer groups. We analyzed the relationship between pretreatment plasma D-dimer levels and clinical and laboratory characteristics in patients with DLBCL. Univariate and multivariate analyses were used to assess prognostic factors for overall survival (OS) and progression-free survival (PFS).ResultsPatients with B symptoms, plasma lactate dehydrogenase levels >upper limit of normal (ULN), poor Eastern Cooperative Oncology Group score (2 to 4), advanced stage (III–IV), >1 extranodal site, higher International Prognostic Index (IPI) (2 to 5) and higher National Comprehensive Cancer Network IPI (NCCN-IPI) (≥4) (all P<0.001) had higher pretreatment plasma D-dimer levels (≥1.4 µg/mL). Patients with higher plasma D-dimer levels had worse OS and PFS (P<0.001 and P=0.001, respectively).ConclusionsHigher pretreatment plasma D-dimer level was associated with poor survival and was an independent poor predictor of OS among untreated patients with DLBCL.

Pretreatment plasma d-dimer levels as an independent prognostic factor for overall survival among patients with advanced non-small-cell lung cancer.

ObjectiveTo evaluate the prognostic accuracy of d-dimer levels for advanced non-small-cell lung cancer (NSCLC).MethodsThis retrospective cohort study included 651 patients initially diagnosed with advanced NSCLC. Patients with d-dimer levels ≥0.5 mg/L were included in the high d-dimer group, whereas patients with lower levels were included in the normal group. Cumulative survival was estimated using Kaplan–Meier curves and compared using the log-rank test. Multivariate analyses were performed using the Cox proportional hazards model.ResultsThe median plasma d-dimer level in the study cohort was 0.61 ± 0.49 mg/L. d-dimer levels were elevated in 60.98% of patients, and 80.1% of such patients had adenocarcinoma. Univariate and multivariate analyses identified d-dimer content as an independent factor for the prognosis of NSCLC (hazard ratio [HR] = 1.54, 95% confidence interval [CI] = 1.19–1.98). Kaplan–Meier analysis revealed that high plasma d-dimer levels were associated with shorter overall survival (HR = 1.48, 95% CI = 1.19–1.84). In addition, the receipt of <2 lines of treatment was associated with a higher risk of death than the receipt of >2 lines.ConclusionThe present results imply that pretreatment plasma d-dimer levels could represent a prognostic factor for advanced NSCLC.

Prognostic value of pretreatment plasma D-dimer level in dogs with intermediate to high-grade non-Hodgkin lymphoma.

Pretreatment D-dimer levels have been reported to predict survival in several types of malignancies in human patients. The objective of this study was to evaluate the prognostic value of pretreatment D-dimer level in dogs with intermediate to high-grade non-Hodgkin lymphoma (NHL). In a prospective, randomized, double-blind study of F14512 vs etoposide phosphate, we assessed the prognostic value of pretreatment plasma D-dimer level in 48 client-owned dogs diagnosed with intermediate to high-grade NHL. The correlation between pretreatment plasma D-dimer level and various clinical features, progression-free survival (PFS) and overall survival (OS) was analysed. The median value of pretreatment plasma D-dimer level was 0.4 μg/mL (range: 0.1-14.3 μg/mL). High pretreatment plasma D-dimer level (>0.5 μg/mL) was detected in 44% (21/48) of dogs. High D-dimer levels were not correlated with naive vs relapsed lymphoma, clinical stage, substage, immunophenotype or treatment group. D-dimer levels >0.5 μg/mL were significantly associated with inferior median PFS (54 vs 104 days, P = .011) and OS (93 vs 169 days, P = .003). In the multivariate analysis, high D-dimer levels remained an independent predictor for worse PFS (HR: 3.21, 95% CI: 1.57-6.56, P = .001) and OS (HR: 3.87, 95% CI: 1.88-7.98; P < .001). This study suggests that pretreatment plasma D-dimer level can serve as a predictor of prognosis in dogs with intermediate to high-grade NHL. Further studies are warranted to confirm these findings.

Preoperative plasma D-dimer level is a useful prognostic marker in ovarian cancer

A high pre-treatment plasma D-dimer level was recently identified as a poor prognostic factor in several malignancies. The aim of this study was to evaluate the prognostic significance of plasma D-dimer levels in epithelial ovarian cancer (EOC). Data of 199 patients were retrospectively analysed. The relationships between pre-treatment D-dimer levels and other clinical parameters and prognosis were evaluated. Univariate analysis identified age, pre-treatment plasma D-dimer level, massive ascites, residual tumours, pre-treatment CA125 level, histological type, and FIGO stage as predictors of overall survival. The multivariate analysis showed that a high pre-treatment plasma D-dimer level (p=.017), residual tumours (p < .001), and FIGO stage (p = .036) were independent risk factors of overall survival. Venous thromboembolism (VTE) did not influence overall survival (p=.091). High pre-treatment D-dimer levels are associated with a poor prognosis independent of VTE status in EOC patients, and might be a useful prognostic biomarker.Impact statementWhat is already known on this subject? In recent years, a high pre-treatment plasma D-dimer level has been identified as a prognostic factor in several malignancies, but only a handful of studies have assessed the role of pre-treatment plasma D-dimer levels in patients with EOC patients. Thus, the clinical significance and prognostic value of the plasma D-dimer level in EOC remain controversial, and there is also debate related to the association of the higher mortality rate among cancer patients with elevated D-dimer levels with VTE.What do the results of this study add? In our study, high pre-treatment D-dimer levels are associated with a poor prognosis independently of VTE in EOC patients.What are the implications of these findings for clinical practice and/or further research? The D-dimer level might emerge as a valuable prognostic biomarker, which will help doctors in the choice of initiating a more aggressive therapy, the combination of chemotherapy with anticoagulation therapy.

High pretreatment plasma D-dimer levels predict poor prognosis in gastrointestinal cancers: A meta-analysis.

Background:High pretreatment plasma D-dimer levels can predict poor prognosis in various types of gastrointestinal carcinomas. Our meta-analysis explored the correlation between plasma D-dimer levels and prognosis in gastrointestinal malignancies.Methods:Two independent reviewers conducted a comprehensive search from PubMed, ScienceDirect, Embase, Web of Science and the Cochrane Library. All articles evaluating the correlation between pretreatment plasma D-dimer levels and prognosis in gastrointestinal malignancies were searched. We chose overall survival (OS) as the primary survival outcome measure and progression-free survival (PFS), disease-free survival (DFS) and cancer-specific survival (CSS) as the secondary survival outcome measures. We extracted hazard ratios (HRs) and 95% confidence intervals (CIs) from the eligible publications.Results:We included 30 studies involving 5928 gastrointestinal cancer patients. There was an obvious correlation between high D-dimer levels and poor OS (HR = 2.01, 95% CI = 1.72–2.36, P < .01). High plasma D-dimer levels were correlated with shorter PFS (HR = 1.34, 95% CI = 1.05–1.70, P = .32), DFS (HR = 1.67, 95% CI = 1.12–2.50, P < .01) and CSS rates (HR = 1.93, 95% CI = 1.49–2.49, P = .66).Conclusions:Elevated pretreatment plasma D-dimer levels might help predict poor prognosis in patients with gastrointestinal malignancies.

High Pretreatment Plasma D-dimer Levels Predict Unfavorable Outcomes in Patients with Neuroblastoma

Background: Neuroblastoma (NB) is the most common malignant solid tumor in children. This study aimed to investigate investigate the prognostic value of pretreatment plasma D-dimer levels, and its relationship with clinical features in patients with NB. Methods: A total of 136 patients were included in this retrospective study. Information of diagnosis, laboratory examination, imaging examination and treatment in medical records was collected. The correlation between plasma D-dimer levels and other clinical characteristics and outcomes was analyzed statistically. Results: Pretreatment plasma D-dimer levels were significantly associated with unfavorable clinical characteristics including INSS III and IV stage, high-risk disease, metastatic disease, MYCN-amplification, poor histologic type, large tumor size, and elevated levels of lactate dehydrogenase (LDH), neuron-specific enolase (NSE) and serum ferritin (SF). Compared to levels before treatment, levels of plasma D-dimer significantly decreased after 2 and 4 cycles of chemotherapy. The patients who had higher D-dimer levels had worse overall survival (3-year OS rate, high vs. middle vs. low D-dimer group, 25.8% ± 7.8% vs. 57.1% ± 10.8% vs. 86.8% ± 4.4%, P< .001) and progression-free survival (3-year PFS rate, high vs. middle vs. low D-dimer group, 17.2% ± 7.2% vs. 43.7% ± 11.6% vs. 70.9% ± 5.9%, P< .001). According to multivariate analysis, high D-dimer level was confirmed to be an independent prognostic factor for OS (high vs. low, HR, 4.715; 95% CI, 1.143-19.452; P= .032). Conclusions: High pretreatment plasma D-dimer levels were remarkably associated with advanced disease and could serve as a novel biomarker predicting the outcomes of NB patients. Funding Statement: This work was sponsored by Personnel training program for distinguished medical young scholar (2017 Kai Li), New hundred people plan of Shanghai health and Family Planning Commission (2017 BR052 Kai Li). Declaration of Interests: All the authors had nothing to disclose. Ethics Approval Statement: This retrospective study was approved by the Ethics Committee of Children’s Hospital of Fudan University. The written informed consents were received from the patients' parents before treatment.

Prognostic significance of pretreatment plasma D-dimer levels in patients with spinal chordoma: a retrospective cohort study.

Plasma D-dimer levels, a marker of hypercoagulation, have not only been used as an indicator for cascaded reaction in the coagulation process but are also reported to be an underlying biomarker in several types of cancers. This retrospective cohort study was designed to evaluate the prognostic value of preoperative plasma D-dimer level in patients with spinal chordoma. We enrolled 224 patients who underwent surgery for spinal chordoma between 2002 and 2015 at Changzheng Orthopedic Oncology Center. Preoperative clinical parameters were recorded and evaluated by univariate and multivariate Cox regression models. The correlation between preoperative plasma D-dimer levels and survival was assessed using the Kaplan-Meier method. The optimal cutoff value of pretreatment D-dimer was 840μg/L determined by X-tile. DFS (disease-free survival) was 64.7% and OS (overall survival) was 75% in the cohort. Multivariate Cox regression model identified D-dimer level as an independent prognostic factor of DFS and OS, as well as treatment history, preoperative Karnofsky Performance Scale, preoperative Frankel score, pathology classification and adjuvant radiotherapy (p < 0.05). In addition, D-dimer level may also be an effective supplement for defining tumor Enneking staging (p < 0.05). Higher pretreatment plasma D-dimer level was associated with a poor prognosis in chordoma and could be used as an independent prognostic factor for the survival of the patients with spinal chordoma. With supplementation of D-dimer level, Enneking stage may be more able to accurate stratify individualized risk and determine clinical management. These slides can be retrieved under Electronic Supplementary Material.

A combined marker based on plasma D-dimer and serum albumin levels in patients with nasopharyngeal carcinoma is associated with poor survival outcomes in a retrospective cohort study

Background: Activation of the clotting-fibrinolytic system in cancer patients is common and results in an unfavorable clinical outcome. This study aimed to investigate the role of pretreatment plasma D-dimer levels and the combination of D-dimer and albumin (DA) on the prediction of survival prognosis in patients with nasopharyngeal carcinoma (NPC).Methods: The study comprised 511 patients with NPC. Pretreatment plasma D-dimer and serum albumin levels were measured. DA was classified as a new biomarker where D-dimer and albumin levels were combined and was grouped by the cutoff value of both. The correlations of plasma D-dimer levels with clinicopathological features and survival outcome were calculated using the Chi-square test. Kaplan-Meier estimates were performed to analyze the survival functions and were compared using log-rank tests. Cox proportional hazard regression analysis was used to assess the effects of D-dimer and DA on distant overall survival (OS) and distant metastasis-free survival (DMFS).Results: The median follow-up period was 45.2 months (range 2.1-79.8). Elevated plasma D-dimer levels were positively associated with age at diagnosis (P = 0.034), platelet levels (P = 0.043), and Epstein Barr Virus (EBV) DNA copy number (P = 0.035). Additionally, multivariate analysis demonstrated that elevated plasma D-dimer levels were strongly associated with a poorer OS (HR 2.074, 95% CI 1.190-3.612, P = 0.010), but not DMFS. After adjustment for other variables, DA stratification acted as an independent prognostic marker for OS (P = 0.038) and DMFS (P = 0.031) in patients with NPC, when combined with albumin levels.Conclusions: Increased plasma D-dimer levels accurately predict poor OS and may be an effective independent prognostic factor in patients with NPC. Moreover, in conjunction with serum albumin, DA may serve as a factor in predicting OS and DMFS.

High Pretreatment Plasma D-Dimer Levels Are Associated with Poor Prognosis in Patients with Newly Diagnosed Diffuse Large B-Cell Lymphomas Treated with Immunochemotherapy

Introduction: The International Prognostic Index (IPI) is the most commonly used tool for predicting the survival of patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). Several clinical factors are being investigated to establish novel prognostic tools that can predict survival more simply and precisely. Plasma levels of D-dimer, a degradation product of fibrin, reflect the activation of coagulation and fibrinolysis. Tissue factors and cytokines released by tumor cells can activate fibrin formation, leading to tumor proliferation and migration. Pretreatment plasma D-dimer levels have been reported to correlate with survival in several types of malignancies, although few reports have assessed the prognostic role of plasma D-dimer levels in DLBCL. This study aimed to investigate the relationship between pretreatment plasma D-dimer levels and overall survival in patients with newly diagnosed DLBCL.Methods: We retrospectively identified 521 patients with DLBCL who were treated with anthracycline-based immunochemotherapy at our institution from January 2005 to December 2017. We excluded 130 patients who lacked records of pretreatment D-dimer levels. The remaining 391 patients were enrolled in this study. The primary endpoint was 5-year overall survival (OS), which was assessed with the Kaplan-Meier method. The optimal cut-off value of D-dimer levels to predict survival was determined using the receiver operating characteristic curve (ROC) analysis. Based on the cut-off value, patients were divided into two groups: the high D-dimer (HD) and low D-dimer (LD) groups. We compared the 5-year OS between the two groups using the log-rank test. Univariate and multivariate analyses for survival were performed using the Cox proportional hazard model. Adjusted covariates included age, Eastern Cooperative Oncology Group performance status (ECOG-PS), lactate dehydrogenase (LDH) levels, Ann-Arbor stages, and number of extranodal sites.Results: The median age of the subjects was 70 (range: 30-92) years. Two hundred and twelve patients (54.2%) were male, and 198 patients (50.6%) had a high-intermediate or high IPI score. The median D-dimer level was 1.4 (range: 0.1-197.0) µg/ml. The cut-off value of D-dimer was determined to be 1.0 µg/ml based on ROC analysis (area under the curve: 0.92, sensitivity: 100.0%, specificity: 83.3%). Compared with the LD group (<1.0 µg/ml, n = 135), the HD group (≥1.0 µg/ml, n = 256) comprised significantly more patients with bad ECOG PS (≥2), high LDH levels (≥250 IU/l), advanced Ann-Arbor stages (III or IV), many extranodal sites (≥2), and high IPI scores (Table 1).With the median follow-up period of 30.5 (range: 0.1-162) months, the 5-year OS of the entire cohort was 65.5% (95% confidence interval [CI]: 59.8-70.6%). The 5-year OS was significantly shorter in the HD group than in the LD group (58.9%, [95% CI: 51.8-65.3%] vs. 77.8%, [95% CI: 67.4-85.2%], p < 0.001, Figure). Univariate analysis identified HD vs. LD (hazard ratio [HR]: 2.65 [95% CI: 1.65-4.26], p < 0.001) to be significantly associated with the worse 5-year OS, which remained significant in the multivariate analysis (HR: 1.94, [95% CI: 1.17-3.21], p = 0.010, Table 2).Conclusions: High pretreatment plasma D-dimer levels were associated with poor prognosis in patients with newly diagnosed DLBCL independent of the IPI score. Further studies are needed to confirm the prognostic role of D-dimer levels in patients with DLBCL. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

High pretreatment plasma D-dimer levels are associated with shorter overall survival in patients with small cell lung cancer.

ObjectiveTo investigate the relationship between pretreatment plasma D-dimer levels and survival in Chinese patients with small cell lung cancer (SCLC).MethodsThis retrospective study enrolled 82 patients with SCLC treated at Beijing Chaoyang Hospital, Capital Medical University, from January 2012 to January 2015. All patients were followed up. Associations between pretreatment plasma D-dimer levels measured by immunoturbidimetric assay and clinical outcomes were analyzed by Kaplan–Meier and multivariate analyses, using a cut-off level of 0.55 mg/L fibrinogen equivalent units (FEU).ResultsMedian progression-free survival (PFS) and overall survival (OS) were significantly higher in patients with low D-dimer levels (≤0.55 mg/L FEU; 8.0 and 17.0 months, respectively) compared with patients with high levels (>0.55 mg/L FEU; 5.0 and 9.0 months, respectively). Plasma D-dimer levels, Karnofsky performance status, N stage, TNM stage, treatment, and neuron-specific enolase (NSE) levels were significantly associated with PFS, while D-dimer levels, N stage, TNM stage, and treatment were significantly associated with OS. Multivariate analysis revealed that TNM stage, treatment, and NSE levels were independently associated with PFS, while D-dimer levels and treatment were independently associated with OS.ConclusionsPretreatment plasma D-dimer levels were independently associated with OS in patients with SCLC.

Prognostic value of pretreatment plasma D-dimer levels in patients with diffuse large B cell lymphoma (DLBCL)

BackgroundWe assessed the prognostic significance of D-dimer in patients of diffuse large B cell lymphoma (DLBCL). MethodsWe performed a retrospective study including 254 patients who were newly diagnosed DLBCL. X-tile was used to generate a cutoff value for D-dimer. Both univariate screen by Cox proportional hazard model and multivariable analysis by Cox regression model were used to assess the impact of pretreatment D-dimer levels on the overall survival (OS). ResultAccording to X-tile, the optimal cut-off value of D-dimer for prediction of survival was set as 1.6 μg/mL, and a D-dimer level ≥ 1.6 μg/mL was significantly associated with poor overall survival (OS) (OS: 31.7 vs. 79.1%, P < 0.001). In multivariable analysis, it was found that a higher D-dimer level was an independent predictor for worse OS (Hazard ratio (HR): 3.594 95% Confidence interval (CI): 2.296–5.267, P < 0.001). In subgroup analysis of International Prognostic Index (IPI), survival of low-risk and intermediate-risk group with a D-dimer level ≥ 1.6 μg/mL were both similar to that of the high-risk group (OS: 31.6 vs. 36.5%, P = 0.957; OS: 38.0 vs. 36.5%, P = 0.758). In addition, among patients treated with surgery, those with higher D-dimer had substantially worse survival than that with lower D-dimer (OS: 27.0 vs. 84.5%, P < 0.001). ConclusionPretreatment D-dimer is a simple but effective predictor of survival among patients with DLBCL.

Prognostic Role of Pretreatment Plasma D-Dimer in Patients with Solid Tumors: a Systematic Review and Meta-Analysis

Background/Aims: Elevated pretreatment plasma D-dimer level has been reported as an unfavorable prognostic indicator in several malignancies. The aim of this meta-analysis was to evaluate the prognostic value of elevated D-dimer level in solid tumors. Methods: A comprehensive search of electronic databases up to June 10, 2017 was carried out by two independent reviewers. We included studies exploring the association between pretreatment plasma D-dimer level and patients’ survival outcomes in solid tumors. Overall survival (OS) was regarded as primary outcome and progression-free survival (PFS), disease-free survival (DFS) as well as cancer-specific survival (CSS) were chosen as secondary outcomes. Hazard ratio and 95% confidence interval (CI) were extracted directly or indirectly from included studies. Results: 49 studies with 13001 patients were included in our meta-analysis. Elevated D-dimer was markedly associated with poor OS (pooled HR = 1.90, 95% CI = 1.63 - 2.20, P < 0.001). The effect was observed in all different tumor sites, disease stages, cut-off values and ethnicities. Meanwhile, patients with a high plasma D-dimer had a shorter PFS (HR = 1.46, 95% CI = 1.22–1.76; P < 0.001), DFS (HR = 2.02, 95% CI = 1.56–2.62) and CSS (HR = 2.04, 95% CI= 1.58 – 2.64). Conclusions: Analysis of the pretreatment plasma D-dimer might provide useful information to predict prognosis in patients with solid tumors.

Impact of pretreatment plasma D-dimer levels and its perioperative change on prognosis in operable esophageal squamous cell carcinoma.

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.

A high plasma D-dimer level predicts poor prognosis in gynecological tumors in East Asia area: a systematic review and meta-analysis.

High pre-treatment plasma D-dimer levels have been reported as a factor associated with a poor prognosis in different types of malignancies, including pancreatic, gastric, colorectal, lung, and nasopharyngeal carcinoma. Here, we performed a meta-analysis to determine the association of plasma D-dimer levels and long term survival in gynecological cancers, including ovarian, cervical and endometrial carcinoma. We searched all eligible publications in PubMed and Web of Science Databases up to August 2016. Primary outcomes, including overall survival (OS), disease-free survival and hazard ratios (HR) of were extracted and analyzed. Heterogeneity and publication bias were also assessed. A total of 7 eligible studies with 1112 cases were included in this study and all included studies are conducted in East Asia area. We found that gynecological cancer patients with high D-dimer demonstrates a much lower 5-year survival rate than those with low D-dimer levels (OR 4.12, 95% CI 3.04-5.58, P<0.00001). No significant heterogeneity is found (I2 = 10 %; P = 0.35). Importantly, pooled analysis showed that high plasma D-dimer levels are predictive of a shorter OS in gynecological cancers (HR 2.09, 95% CI 1.59-2.74). No heterogeneity is observed (I2=5%, P=0.39). Additionally, a subgroup analysis of ovarian cancer is conducted. In conclusion, this meta-analysis showed that a high plasma D-dimer level predicts poor prognosis in gynecological tumors.

Hypercoagulability and Mortality of Patients with Stroke and Active Cancer: The OASIS-CANCER Study.

Background and PurposePatients with active cancer are at an increased risk for stroke. Hypercoagulability plays an important role in cancer-related stroke. We aimed to test whether 1) hypercoagulability is a predictor of survival, and 2) correction of the hypercoagulable state leads to better survival in patients with stroke and active cancer.MethodsWe recruited consecutive patients with acute ischemic stroke and active systemic cancer between January 2006 and July 2015. Hypercoagulability was assessed using plasma D-dimer levels before and after 7 days of anticoagulation treatment. The study outcomes included overall and 1-year survival. Plasma D-dimer levels before and after treatment were tested in univariate and multivariate Cox regression models. We controlled for systemic metastasis, stroke mechanism, age, stroke severity, primary cancer type, histology, and atrial fibrillation using the forward stepwise method.ResultsA total of 268 patients were included in the analysis. Patients with high (3rd–4th quartiles) pre-treatment plasma D-dimer levels showed decreased overall and 1-year survival (adjusted HR, 2.19 [95% CI, 1.46–3.31] and 2.70 [1.68–4.35], respectively). After anticoagulation treatment, post-treatment D-dimer level was significantly reduced and independently associated with poor 1-year survival (adjusted HR, 1.03 [95% CI, 1.01–1.05] per 1 μg/mL increase, P=0.015). The successful correction of hypercoagulability was a protective factor for 1-year survival (adjusted HR 0.26 [CI 0.10–0.68], P=0.006).ConclusionsHypercoagulability is associated with poor survival after stroke in patients with active cancer. Effective correction of hypercoagulability may play a protective role for survival in these patients.

High pretreatment plasma D-dimer levels are related to shorter overall survival in endometrial carcinoma

ObjectiveThe aim of the present study was to evaluate the prognostic value of pretreatment plasma dimerized plasmin fragment D (D-dimer) levels in endometrial carcinoma after adjusting for venous thromboembolism (VTE). Study designThe relationships between the following clinical parameters from 110 patients were investigated: age, histological type, the International Federation of Gynecology and Obstetrics (FIGO) stage, tumor grade, pretreatment plasma D-dimer level, platelet count, fibrinogen, CA19-9, and CEA levels, progression-free survival (PFS), and overall survival (OS). A survival analysis was performed using the Kaplan–Meier method, and prognostic factors were assessed using Cox's proportional hazards regression model. ResultsHigh pretreatment D-dimer levels were detected in 32% of cases. High D-dimer levels correlated with an advanced tumor stage, histological type, and tumor grade (P=0.001, P=0.021, P=0.044). A multivariate analysis identified high D-dimer levels as an independent prognostic factor for OS (P=0.013), whereas the histological type, but not D-dimer levels had independent prognostic value for PFS (P=0.225). ConclusionHigh pretreatment D-dimer levels have an impact on prognoses independently of VTE, and also have potential as markers to predict surgical outcomes in patients with endometrial carcinoma. Pretreatment D-dimer levels may contribute to the identification of high-risk populations for treatment decisions.

High Pretreatment D-Dimer Levels Correlate with Adverse Clinical Features and Predict Poor Survival in Patients with Natural Killer/T-Cell Lymphoma.

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.