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D-Dimer Can Serve as a Prognostic and Predictive Biomarker for Metastatic Gastric Cancer Treated by Chemotherapy.

Go SI, Lee MJ, Lee WS, Choi HJ, Lee US, Kim RB, Kang MH, Kim HG, Lee GW, Kang JH, Lee JH, Kim SJ - Medicine (Baltimore) (2015)

Bottom Line: D-dimer levels were assessed before CTx and at the first response evaluation after CTx.The overall survival (OS) of patients with pretreatment D-dimer levels <1.5 μg/mL was significantly longer than that of patients with D-dimer levels ≥1.5 μg/mL (22.0 vs 7.9 months, P = 0.019).At the first response evaluation, the mean level of D-dimer was significantly decreased by 2.11 μg/mL in patients either with partial response or stable disease (P = 0.011) whereas the mean level of D-dimer, although the difference did not reach statistical significance, was increased by 2.46 μg/mL in patients with progressive disease.In addition, the OS of patients with D-dimer levels <1.0 μg/mL at the first response evaluation was significantly longer than that of patients with D-dimer levels ≥1.0 μg/mL (22.0 vs 7.0 months, P = 0.009).

View Article: PubMed Central - PubMed

Affiliation: From the Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea (S-IG, MJL, WSL, HJC, USL, MHK, H-GK, G-WL, JHK); Department of Preventive Medicine and Environmental Health Center, Gyeongsang National University School of Medicine, Jinju, Korea (RBK), Department of Pathology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea (JHL); and Department of Laboratory Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea (SJK).

ABSTRACT
Systemic activation of hemostasis and thrombosis has been implicated in tumor progression and metastasis. D-dimer has been used as an indicator for the thrombosis. Here, we investigated the role of the activation of coagulation in patients with metastatic gastric cancer by measuring D-dimer level.We conducted an observation study of 46 metastatic gastric cancer patients who received palliative chemotherapy (CTx). D-dimer levels were assessed before CTx and at the first response evaluation after CTx.The overall survival (OS) of patients with pretreatment D-dimer levels <1.5 μg/mL was significantly longer than that of patients with D-dimer levels ≥1.5 μg/mL (22.0 vs 7.9 months, P = 0.019). At the first response evaluation, the mean level of D-dimer was significantly decreased by 2.11 μg/mL in patients either with partial response or stable disease (P = 0.011) whereas the mean level of D-dimer, although the difference did not reach statistical significance, was increased by 2.46 μg/mL in patients with progressive disease. In addition, the OS of patients with D-dimer levels <1.0 μg/mL at the first response evaluation was significantly longer than that of patients with D-dimer levels ≥1.0 μg/mL (22.0 vs 7.0 months, P = 0.009). The lower D-dimer levels (<1.0 μg/mL) at the first response evaluation after CTx was independent predictive factor for better survival in multivariate analysis (P = 0.037).This study suggests that D-dimer levels may serve as a biomarker for response to CTx and OS in patients with metastatic gastric cancer.

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Related in: MedlinePlus

OS curve by D-dimer levels. (A) Patients with D-dimer levels <1.5 μg/mL at the pretreatment showed a significantly longer OS than those with D-dimer levels ≥1.5 μg/mL (median OS, 22.0 vs 7.9 mo, respectively). (B) Patients with D-dimer levels <1.0 μg/mL at the first response evaluation showed a significantly longer OS than those with D-dimer levels ≥1.0 μg/mL (median OS, 22.0 vs 7.0 mo, respectively). OS = overall survival.
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Figure 3: OS curve by D-dimer levels. (A) Patients with D-dimer levels <1.5 μg/mL at the pretreatment showed a significantly longer OS than those with D-dimer levels ≥1.5 μg/mL (median OS, 22.0 vs 7.9 mo, respectively). (B) Patients with D-dimer levels <1.0 μg/mL at the first response evaluation showed a significantly longer OS than those with D-dimer levels ≥1.0 μg/mL (median OS, 22.0 vs 7.0 mo, respectively). OS = overall survival.

Mentions: Median follow-up duration was 16.2 months (range: 2.2–25.8 months) and median OS was 10.5 months. In survival analysis, the group with high pretreatment D-dimer level was associated with worse survival than that with low pretreatment D-dimer level (median OS, 22.0 vs 7.9 months, P = 0.019, P = 0.171 after Bonferroni correction; Figure 3A). The patients with high D-dimer level (≥1.0 μg/mL) at the first response evaluation also showed shorter OS than those with low D-dimer (<1.0 μg/mL) (median OS, 22.0 vs 7.0 months, P = 0.009, P = 0.045 after Bonferroni correction; Figure 3B).


D-Dimer Can Serve as a Prognostic and Predictive Biomarker for Metastatic Gastric Cancer Treated by Chemotherapy.

Go SI, Lee MJ, Lee WS, Choi HJ, Lee US, Kim RB, Kang MH, Kim HG, Lee GW, Kang JH, Lee JH, Kim SJ - Medicine (Baltimore) (2015)

OS curve by D-dimer levels. (A) Patients with D-dimer levels <1.5 μg/mL at the pretreatment showed a significantly longer OS than those with D-dimer levels ≥1.5 μg/mL (median OS, 22.0 vs 7.9 mo, respectively). (B) Patients with D-dimer levels <1.0 μg/mL at the first response evaluation showed a significantly longer OS than those with D-dimer levels ≥1.0 μg/mL (median OS, 22.0 vs 7.0 mo, respectively). OS = overall survival.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554111&req=5

Figure 3: OS curve by D-dimer levels. (A) Patients with D-dimer levels <1.5 μg/mL at the pretreatment showed a significantly longer OS than those with D-dimer levels ≥1.5 μg/mL (median OS, 22.0 vs 7.9 mo, respectively). (B) Patients with D-dimer levels <1.0 μg/mL at the first response evaluation showed a significantly longer OS than those with D-dimer levels ≥1.0 μg/mL (median OS, 22.0 vs 7.0 mo, respectively). OS = overall survival.
Mentions: Median follow-up duration was 16.2 months (range: 2.2–25.8 months) and median OS was 10.5 months. In survival analysis, the group with high pretreatment D-dimer level was associated with worse survival than that with low pretreatment D-dimer level (median OS, 22.0 vs 7.9 months, P = 0.019, P = 0.171 after Bonferroni correction; Figure 3A). The patients with high D-dimer level (≥1.0 μg/mL) at the first response evaluation also showed shorter OS than those with low D-dimer (<1.0 μg/mL) (median OS, 22.0 vs 7.0 months, P = 0.009, P = 0.045 after Bonferroni correction; Figure 3B).

Bottom Line: D-dimer levels were assessed before CTx and at the first response evaluation after CTx.The overall survival (OS) of patients with pretreatment D-dimer levels <1.5 μg/mL was significantly longer than that of patients with D-dimer levels ≥1.5 μg/mL (22.0 vs 7.9 months, P = 0.019).At the first response evaluation, the mean level of D-dimer was significantly decreased by 2.11 μg/mL in patients either with partial response or stable disease (P = 0.011) whereas the mean level of D-dimer, although the difference did not reach statistical significance, was increased by 2.46 μg/mL in patients with progressive disease.In addition, the OS of patients with D-dimer levels <1.0 μg/mL at the first response evaluation was significantly longer than that of patients with D-dimer levels ≥1.0 μg/mL (22.0 vs 7.0 months, P = 0.009).

View Article: PubMed Central - PubMed

Affiliation: From the Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea (S-IG, MJL, WSL, HJC, USL, MHK, H-GK, G-WL, JHK); Department of Preventive Medicine and Environmental Health Center, Gyeongsang National University School of Medicine, Jinju, Korea (RBK), Department of Pathology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea (JHL); and Department of Laboratory Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea (SJK).

ABSTRACT
Systemic activation of hemostasis and thrombosis has been implicated in tumor progression and metastasis. D-dimer has been used as an indicator for the thrombosis. Here, we investigated the role of the activation of coagulation in patients with metastatic gastric cancer by measuring D-dimer level.We conducted an observation study of 46 metastatic gastric cancer patients who received palliative chemotherapy (CTx). D-dimer levels were assessed before CTx and at the first response evaluation after CTx.The overall survival (OS) of patients with pretreatment D-dimer levels <1.5 μg/mL was significantly longer than that of patients with D-dimer levels ≥1.5 μg/mL (22.0 vs 7.9 months, P = 0.019). At the first response evaluation, the mean level of D-dimer was significantly decreased by 2.11 μg/mL in patients either with partial response or stable disease (P = 0.011) whereas the mean level of D-dimer, although the difference did not reach statistical significance, was increased by 2.46 μg/mL in patients with progressive disease. In addition, the OS of patients with D-dimer levels <1.0 μg/mL at the first response evaluation was significantly longer than that of patients with D-dimer levels ≥1.0 μg/mL (22.0 vs 7.0 months, P = 0.009). The lower D-dimer levels (<1.0 μg/mL) at the first response evaluation after CTx was independent predictive factor for better survival in multivariate analysis (P = 0.037).This study suggests that D-dimer levels may serve as a biomarker for response to CTx and OS in patients with metastatic gastric cancer.

Show MeSH
Related in: MedlinePlus