The predictive value of D-dimer measurement for cancer in patients with deep vein thrombosis.
The predictive value of D-dimer measurement for cancer in patients with deep vein thrombosis.
复制标题
D-二聚体测量对深静脉血栓患者癌症的预测价值。
作者：
R. Schutgens;M. Beckers;F. Haas;D. Biesma
背景和目标
静脉血栓栓塞可能与恶性肿瘤有关，但对深静脉血栓形成（DVT）患者进行常规癌症筛查并不是推荐的做法。本研究的目的是评估D-二聚体浓度在预测DVT患者癌症中的价值。
设计和方法
D-二聚体水平测定与DVT的门诊病人。在一部分患者中，每天测量D-二聚体水平，持续4天。记录恶性肿瘤的发生。
结果
患者的中位随访时间为34个月。在研究期间，218例血栓形成患者中有50例（23%）患有癌症，其中14例在随访期间发生癌症。高初始D-二聚体水平（水平> 4000 mg/L）与随访期间更多的癌症相关，而低D-二聚体水平：13%对4%（p=0.048）。治疗4天后，高D-二聚体水平与15%的癌症患病率相关，而低D-二聚体水平患者的患病率为5%（p=0.1）。初始D-二聚体水平< 4000 mg/L患者的总癌症患病率（包括血栓形成前诊断的癌症）为16%，而较高水平患者为32%（p=0.009，RR=2.0）。治疗4天后，总癌症患病率分别为14%和46%（p=0.02，RR=3.4）。在年龄< 60岁的患者中，初始D-二聚体水平< 4000 mg/L与3%的癌症患病率相关，而较高水平与23%的患病率相关（p=0.001，RR=8.6）。治疗4天后，与D-二聚体水平较低和较高相关的患病率分别为0%和100%（p=0.003）。老年患者无差异。
解释和结论
在就诊时或治疗的第一天，D-二聚体浓度高是显性或隐性癌症的可能性增加的指标，特别是在60岁以下的患者中。
BACKGROUND AND OBJECTIVES
Venous thromboembolism can be related to malignancy, but routine screening for cancer in patients with deep vein thrombosis (DVT) is not a recommended practice. The aim of this study was to evaluate the value of D-dimer concentration in predicting cancer in patients with DVT.
DESIGN AND METHODS
D-dimer levels were measured in outpatients presenting with DVT. In a proportion of patients, D-dimer levels were measured daily for 4 days. The occurrence of malignancy was documented.
RESULTS
Patients were followed for a median of 34 months. Fifty (23%) of 218 patients with thrombosis had cancer in the study period including 14 who developed cancer during the follow-up. High initial D-dimer levels (levels > 4000 mg/L) were associated with more cancer during follow-up than were lower D-dimer levels: 13% versus 4% (p=0.048). High D-dimer levels after 4 days of treatment were associated with a 15% prevalence of cancer whereas the prevalence in patients with lower D-dimer levels was 5% (p=0.1). The total cancer prevalence (including cancer diagnosed before thrombosis) in patients with initial D-dimer levels < 4000 mg/L was 16% compared to 32% in patients with higher levels (p=0.009, RR=2.0). After 4 days of treatment, total cancer prevalences were 14% and 46%, respectively (p=0.02, RR=3.4). In patients aged < 60 years, initial D-dimer levels of < 4000 mg/L were associated with a cancer prevalence of 3% whereas higher levels were associated with a prevalence of 23% (p=0.001, RR=8.6). After 4 days of treatment, the prevalences associated with lower and higher levels of D-dimer were 0% and 100%, respectively (p=0.003). There was no difference in older patients.
INTERPRETATION AND CONCLUSIONS
High D-dimer concentrations at presentation or during the first days of treatment are indicators of an increased probability of overt or occult forms of cancer, especially in patients under 60 years old.
影响因子：
45.3
作者：
Blackwell, K;Haroon, Z;Greenberg, C
通讯作者：
Greenberg, C
影响因子：
20.3
作者：
Cushman, M;Folsom, AR;Heckbert, SR
通讯作者：
Heckbert, SR