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

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.

Fibrinogen and D‐dimer levels elevate in advanced hepatocellular carcinoma: High pretreatment fibrinogen levels predict poor outcomes

“…Previous studies have reported that high levels of plasma fibrinogen and/or D‐dimer are associated with poor prognosis in several solid malignancies . In this study, we found a significantly increased risk of disease progression and death in HCC patients with hyperfibrinogenemia.…”

“…Previous studies have reported that plasma fibrinogen and/or D‐dimer levels can predict poor prognosis in several types of malignancies including ovarian, breast, colorectal, lung, gastric, and pancreatic cancer . In lung cancer, plasma fibrinogen and D‐dimer levels have been shown to be associated with tumor pathological stage, response to therapy, and survival .…”

Coagulation and fibrinolysis in gastric cancer

“…B). Moreover, cancer cells activate monocytes, macrophages, and platelets, which adhere to tumor cells and facilitate tumor growth and metastasis . There is a complex interplay between platelet‐induced tumor growth and tumor cell–induced platelet activation, with the involvement of multiple components within the tumor microenvironment that enhance metastasis .…”

D-dimer is an essential accompaniment of circulating tumor cells in gastric cancer

“…D-dimer, the final stable product of fibrin, which elevated after enhanced activation of Coagulation and fibrinolysis system, widely used in detect and exclude deep vein thrombosis and associated thromboembolic diseases [6–8]. Recent years, several studies reported that plasma D-dimer elevated in malignant tumors and its expression levels positively correlates with an advanced tumor stage, overall survival and therapy response [9–16]. In our previous study in GC patients, we found, D-dimer can better predict asymptomatic visceral metastasis than FIB and other factors [16].…”