Tumor-Specific D-Dimer Concentration Ranges and Influencing Factors: A Cross-Sectional Study

Abstract

D-dimer level in cancer patients is associated with risk of venous thromboembolism and deep venous thrombosis. Most cancer patients have “abnormal” D-dimer levels based on the current normal reference range. To investigate tumor-specific D-dimer reference range, we compared D-dimer levels for nine different tumour types with healthy controls by using simultaneous quantile regression and constructing a median, 5th percentile, and 95th percentile model of normal tumour D-dimer concentration. Associations with tumour primary site, stage, pathological type, and treatment were also explored. Additionally, 190 patients were tracked to reveal the relevance of initial D-dimer levels to cancer prognosis. D-dimer ranges (median, 5th, 95th) in various cancers (mg/L) were: liver 1.12, 0.27, 5.25; pancreatic 0.96, 0.23, 4.81; breast 0.44, 0.2, 2.17; gastric 0.65, 0.22, 5.03; colorectal 0.73, 0.22, 4.45; lung 0.7, 0.25, 4.0; gynaecological 0.61, 0.22, 3.98; oesophageal 0.23, 0.7, 3.45; and head and neck 0.22, 0.44, 2.19. All were significantly higher than that of healthy controls (0.18, 0.07, 0.57). D-dimer peaked 1–2 days postoperatively but had decreased to the normal range by 1 week. Additionally, cancer patients with high initial D-dimer were shown a tendency of poor prognosis in survival rate. In conclusion, D-dimer levels in cancer depend on patient age, tumour primary site, and tumour stage. Thrombosis prevention is necessary if D-dimer has not decreased to the tumor-specific baseline a week after surgery.

The Association between D-Dimer and Prognosis in the Patients with Oral Cancer

“…Although there was a significant difference in OS when patients were stratified according to D-dimer with low D-dimer (<0.7) and high D-dimer (≥0.7) (p = 0.035) in our study, not selected as a predictive factor in multivariate survival analysis. It was reported that H&N cancers have lower metastatic rates and a more favorable prognosis than other malignancies and the D-dimer level was lower than other ones [6]. Our OC cases may correlate with these previous results of lower metastatic rates and a favorable prognosis than other cancers.…”

“…Therefore, the preoperative higher D-dimer values represented a more effective anticoagulation system in patients with free flap success [10]. On the other hand, D-dimer level was independent of gender but was affected by the age of the patient [6]. In our study, there was no significant difference in gender but in age between D-dimer (<0.7 and ≥0.7).…”

“…The ranges of D-dimer levels in head and neck (H&N) cancer patients differed from other malignancies. D-dimer levels in patients with the H&N cancer were much lower than those in patients with gynecological, esophageal, stomach, colorectal, or lung cancer because H&N cancers have lower metastatic rates and a more favorable prognosis than these malignancies [6]. To the best of our knowledges, there was only one report that high D-dimer levels were associated with OS and an increased risk of mortality in nasopharyngeal cancer patients [7].…”

“…The D-dimer range of H&N cancer was 0.22, 0.44, and 2.19 (median, 5th, 95th). Various cancer patients with high initial D-dimer were shown a tendency of poor prognosis in survival rate [6]. Some studies report that D-dimer levels have a relation to tumor stage, prognosis, and lymph node metastasis, as well as OS in patients with solid tumors, such as lung, breast, gastric, colon cancers [1][2][3][4].…”

High pretreatment plasma D-dimer predicts poor survival of colorectal cancer: insight from a meta-analysis of observational studies

“…As Yu et al reported, we could not assess D-dimer status exactly according to normal reference range in the patients with cancers [ 36 ]. Thus, tumor-specific D-dimer reference range should be further investigated with more epidemiological studies and provides a useful standard for clinical practice.…”