High pretreatment plasma D-dimer levels predict poor prognosis in gastrointestinal cancers

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Abstract

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.

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Most cited references 48

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Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints.

M Parmar, V. Torri, L. Stewart (1998)

Meta-analyses aim to provide a full and comprehensive summary of related studies which have addressed a similar question. When the studies involve time to event (survival-type) data the most appropriate statistics to use are the log hazard ratio and its variance. However, these are not always explicitly presented for each study. In this paper a number of methods of extracting estimates of these statistics in a variety of situations are presented. Use of these methods should improve the efficiency and reliability of meta-analyses of the published literature with survival-type endpoints.

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Epidemiology of cancer-associated venous thrombosis.

Jasmijn F. Timp, Sigrid K Braekkan, Henri Versteeg … (2013)

Cancer-associated venous thrombosis is a common condition, although the reported incidence varies widely between studies depending on patient population, start and duration of follow-up, and the method of detecting and reporting thrombotic events. Furthermore, as cancer is a heterogeneous disease, the risk of venous thrombosis depends on cancer types and stages, treatment measures, and patient-related factors. In general, cancer patients with venous thrombosis do not fare well and have an increased mortality compared with cancer patients without. This may be explained by the more aggressive type of malignancies associated with this condition. It is hypothesized that thromboprophylaxis in cancer patients might improve prognosis and quality of life by preventing thrombotic events. However, anticoagulant treatment leads to increased bleeding, particularly in this patient group, so in case of proven benefit of thromboprophylaxis, only patients with a high risk of venous thrombosis should be considered. This review describes the literature on incidence of and risk factors for cancer-associated venous thrombosis, with the aim to provide a basis for identification of high-risk patients and for further development and refinement of prediction models. Furthermore, knowledge on risk factors for cancer-related venous thrombosis may enhance the understanding of the pathophysiology of thrombosis in these patients.

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High D-dimer levels are associated with poor prognosis in cancer patients.

Peter Quehenberger, Christoph Zielinski, Oswald Wagner … (2012)

Systemic activation of hemostasis is frequently observed in cancer patients, even in the absence of thrombosis. Moreover, this activation has been implicated in tumor progression, angiogenesis and metastatic spread. Increased levels of D-dimer, which is a degradation product of cross-linked fibrin, indicate a global activation of hemostasis and fibrinolysis. In a prospective and observational cohort study, we assessed the prognostic value of D-dimer levels for overall survival and mortality risk in 1178 cancer patients included in the Vienna Cancer and Thrombosis Study (CATS). Patients were followed over 2 years at regular intervals until occurrence of symptomatic venous thromboembolism or death. D-dimer levels were measured with a quantitative D-dimer latex agglutination assay The main solid tumors were malignancies of the lung (n=182), breast (n=157), lower gastrointestinal tract (n=133), pancreas (n=74), stomach (n=50), kidney (n=37), prostate (n=133), and brain (n=148); 201 of the patients had hematologic malignancies; 63 had other tumors. During a median follow-up of 731 days, 460 (39.0%) patients died. The overall survival probabilities for patients with D-dimer levels categorized into four groups based on the 1(st), 2(nd) and 3(rd) quartiles of the D-dimer distribution in the total study population were 88%, 82%, 66% and 53% after 1 year, and 78%, 66%, 50% and 30% after 2 years, respectively (P<0.001). The univariate hazard ratio of D-dimer (per double increase) for mortality was 1.5 (95% confidence interval: 1.4-1.6, P<0.001) and remained increased in multivariable analysis including tumor subgroups, age, sex and venous thromboembolism. High D-dimer levels were associated with poor overall survival and increased mortality risk in cancer patients.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: July 2019

Publication date (Electronic): 19 July 2019

Volume: 98

Issue: 29

Electronic Location Identifier: e16520

Affiliations

[a ]Oncology Department, Traditional Chinese Medicine Hospital of Jiulongpo District in Chongqing

[b ]College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China.

Author notes

[∗ ]Correspondence: Jian Shen, Oncology Department, Traditional Chinese Medicine Hospital of Jiulongpo District in Chongqing, No. 160 Longquan College Road, Mawang Township, Jiulongpo District, Chongqing 400080, China (e-mail: shjiansci@ 123456163.com ).

Article

Publisher ID: MD-D-19-01462 Accession ID: 16520

DOI: 10.1097/MD.0000000000016520

PMC ID: 6709134

PubMed ID: 31335729

SO-VID: ab229369-3a38-42b3-8474-199c590e6743

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

History

Date received : 25 February 2019

Date revision received : 26 May 2019

Date accepted : 24 June 2019

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Keywords: clinical value,d-dimer,gastrointestinal carcinoma,meta-analysis,prognosis

Data availability:

Keywords: clinical value, d-dimer, gastrointestinal carcinoma, meta-analysis, prognosis

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

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Most cited references 48

Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints.

Epidemiology of cancer-associated venous thrombosis.

High D-dimer levels are associated with poor prognosis in cancer patients.

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