High D-dimer levels are associated with poor prognosis in cancer patients
High D-dimer levels are associated with poor prognosis in cancer patients
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DOI：
10.3324/haematol.2011.054718
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发表时间：
2012-08-01
期刊：
影响因子：
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通讯作者：
Pabinger, Ingrid
中科院分区：
文献类型：
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作者：
Ay, Cihan;Dunkler, Daniela;Pabinger, Ingrid
背景：即使在没有血栓形成的情况下，癌症患者也经常可以观察到系统激活止血。此外，这种激活与肿瘤进展、血管生成和转移扩散有关。D-二聚体水平的升高表明止血和纤溶的全球激活。设计与方法在一项前瞻性和观察性的队列研究中，我们评估了维也纳癌症和血栓研究(CATS)中1178名癌症患者D-二聚体水平对总体生存和死亡风险的预后价值。定期对患者进行2年以上的随访，直到出现症状性静脉血栓栓塞症或死亡。结果实体瘤主要为肺部恶性肿瘤182例，乳腺恶性肿瘤157例，下消化道恶性肿瘤133例，胰腺恶性肿瘤74例，胃肿瘤50例，肾脏肿瘤37例，前列腺肿瘤133例，脑肿瘤148例，恶性血液病201例，其他肿瘤63例。在731天的中位随访期内，460名患者(39.0%)死亡。根据D-二聚体在人群中分布的第1、2和第3个四分位数将D-二聚体水平的患者分为4组，1年后总的生存概率分别为88%、82%、66%和53%，2年后分别为78%、66%、50%和30%(P<0.05)。
BackgroundSystemic activation of hemostasis is frequently observed in cancer patients, even in the absence of thrombosis. Moreover, this activation has been implicated in tumor progression, angiogenesis and metastatic spread. Increased levels of D-dimer, which is a degradation product of cross-linked fibrin, indicate a global activation of hemostasis and fibrinolysis.Design and MethodsIn a prospective and observational cohort study, we assessed the prognostic value of D-dimer levels for overall survival and mortality risk in 1178 cancer patients included in the Vienna Cancer and Thrombosis Study (CATS). Patients were followed over 2 years at regular intervals until occurrence of symptomatic venous thromboembolism or death. D-dimer levels were measured with a quantitative D-dimer latex agglutination assayResultsThe main solid tumors were malignancies of the lung (n=182), breast (n=157), lower gastrointestinal tract (n=133), pancreas (n=74), stomach (n=50), kidney (n=37), prostate (n=133), and brain (n=148); 201 of the patients had hematologic malignancies; 63 had other tumors. During a median follow-up of 731 days, 460 (39.0%) patients died. The overall survival probabilities for patients with D-dimer levels categorized into four groups based on the 1st, 2nd and 3rd quartiles of the D-dimer distribution in the total study population were 88%, 82%, 66% and 53% after 1 year, and 78%, 66%, 50% and 30% after 2 years, respectively (P