TY - JOUR
T1 - Prognostic significance of elevated D-dimer for survival in patients with sarcoma
AU - Raj, Sean D.
AU - Zhou, Xiao
AU - Bueso-Ramos, Carlos E.
AU - Ravi, Vinod
AU - Patel, Shreyaskumar
AU - Benjamin, Robert S.
AU - Vadhan-Raj, Saroj
PY - 2012/10
Y1 - 2012/10
N2 - BACKGROUND: Elevated levels of D-dimer, a marker for the systemic activation of the clotting and fibrinolysis, are frequently observed in patients with venous thromboembolism (VTE) and malignancy. We examined the prognostic significance of baseline plasma D-dimer levels for predicting survival in sarcoma. METHODS: The study comprised of 45 patients receiving first-line chemotherapy for inoperable, high-risk for relapse, or metastatic disease. Plasma D-dimer levels was measured before chemotherapy. Univariate and multivariate analysis were performed for association between plasma D-dimer levels and baseline clinical characteristics in predicting survival. RESULTS: D-dimer levels were elevated to ≥500 ng/mL in 53% (24 of 45 patients). Six of 45 patients (13%) developed VTE. The Kaplan-Meier analysis showed that the median survival for patients with VTE, metastatic disease, progression on chemotherapy, or D-dimer ≥500 ng/mL was shorter (log-rank test, P=0.012, 0.001, 0.034, and 0.015, respectively). The mortality rate for patients with D-dimer ≥500 ng/mL was higher (P<0.0001) than those with <500 ng/ml for both metastatic (100% vs. 62.5%) and nonmetastatic (58% vs. 31%) groups [median follow-up; 60 mo (range, 9 to 106 mo)]. Using stepwise proportional hazard model, D-dimer levels and metastasis status were independent significant predictors for survival [hazard ratios (95% confidence intervals), 4.24 (1.88-9.60), and 3.28 (1.42-7.58), respectively]. CONCLUSIONS: Elevated D-dimer levels have independent significant prognostic value for survival in sarcoma patients with both metastatic and nonmetastatic disease and may help identify high-risk patients for treatment decisions.
AB - BACKGROUND: Elevated levels of D-dimer, a marker for the systemic activation of the clotting and fibrinolysis, are frequently observed in patients with venous thromboembolism (VTE) and malignancy. We examined the prognostic significance of baseline plasma D-dimer levels for predicting survival in sarcoma. METHODS: The study comprised of 45 patients receiving first-line chemotherapy for inoperable, high-risk for relapse, or metastatic disease. Plasma D-dimer levels was measured before chemotherapy. Univariate and multivariate analysis were performed for association between plasma D-dimer levels and baseline clinical characteristics in predicting survival. RESULTS: D-dimer levels were elevated to ≥500 ng/mL in 53% (24 of 45 patients). Six of 45 patients (13%) developed VTE. The Kaplan-Meier analysis showed that the median survival for patients with VTE, metastatic disease, progression on chemotherapy, or D-dimer ≥500 ng/mL was shorter (log-rank test, P=0.012, 0.001, 0.034, and 0.015, respectively). The mortality rate for patients with D-dimer ≥500 ng/mL was higher (P<0.0001) than those with <500 ng/ml for both metastatic (100% vs. 62.5%) and nonmetastatic (58% vs. 31%) groups [median follow-up; 60 mo (range, 9 to 106 mo)]. Using stepwise proportional hazard model, D-dimer levels and metastasis status were independent significant predictors for survival [hazard ratios (95% confidence intervals), 4.24 (1.88-9.60), and 3.28 (1.42-7.58), respectively]. CONCLUSIONS: Elevated D-dimer levels have independent significant prognostic value for survival in sarcoma patients with both metastatic and nonmetastatic disease and may help identify high-risk patients for treatment decisions.
KW - D-dimer
KW - metastasis
KW - prognosis
KW - sarcoma
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=84866733709&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84866733709&partnerID=8YFLogxK
U2 - 10.1097/COC.0b013e31821d4529
DO - 10.1097/COC.0b013e31821d4529
M3 - Article
C2 - 21654313
AN - SCOPUS:84866733709
SN - 0277-3732
VL - 35
SP - 462
EP - 467
JO - American Journal of Clinical Oncology: Cancer Clinical Trials
JF - American Journal of Clinical Oncology: Cancer Clinical Trials
IS - 5
ER -