A high plasma D-dimer level predicts poor prognosis in gynecological tumors in East Asia area: a systematic review and meta-analysis

Abstract

High pre-treatment plasma D-dimer levels have been reported as a factor associated with a poor prognosis in different types of malignancies, including pancreatic, gastric, colorectal, lung, and nasopharyngeal carcinoma. Here, we performed a meta-analysis to determine the association of plasma D-dimer levels and long term survival in gynecological cancers, including ovarian, cervical and endometrial carcinoma. We searched all eligible publications in PubMed and Web of Science Databases up to August 2016. Primary outcomes, including overall survival (OS), disease-free survival and hazard ratios (HR) of were extracted and analyzed. Heterogeneity and publication bias were also assessed. A total of 7 eligible studies with 1112 cases were included in this study and all included studies are conducted in East Asia area. We found that gynecological cancer patients with high D-dimer demonstrates a much lower 5-year survival rate than those with low D-dimer levels (OR 4.12, 95% CI 3.04-5.58, P<0.00001). No significant heterogeneity is found (I2 = 10 %; P = 0.35). Importantly, pooled analysis showed that high plasma D-dimer levels are predictive of a shorter OS in gynecological cancers (HR 2.09, 95% CI 1.59-2.74). No heterogeneity is observed (I2=5%, P=0.39). Additionally, a subgroup analysis of ovarian cancer is conducted. In conclusion, this meta-analysis showed that a high plasma D-dimer level predicts poor prognosis in gynecological tumors.

Diagnostic value of serum D‐dimer,CA125, and neutrophil‐to‐lymphocyte ratio in differentiating ovarian cancer and endometriosis

“…In agreement with previous findings, the present study found that the ovarian cancer group had significantly higher D‐dimer levels. The AUC for log(D‐dimer) showed high sensitivity (93.2%) and specificity (87.5%) for diagnosis of cancer.…”

“…In ovarian cancer, especially advanced‐stage disease, there is often an underlying state of hypercoagulation and exaggerated fibrinolysis. Tumor cells can activate the clotting–fibrinolytic system and release various procoagulant fibrinolytic markers and hemostatic factors, which in turn stimulate proliferation and differentiation of vascular endothelial cells to promote neoangiogenesis . The present results indicate that D‐dimer is a useful biomarker with high sensitivity and specificity in the diagnosis of ovarian cancer.…”

“…Elevated plasma D‐dimer levels usually indicate active fibrinolysis and are observed in several disorders, including arterial and venous thromboembolic disease, disseminated intravascular coagulation, malignancy, and renal and liver disease . Serum D‐dimer has been reported as a useful diagnosis and prognosis parameter for several malignancies including ovarian cancer . In addition, some studies have shown an association between elevated D‐dimer and rupture of ovarian endometriotic cysts .…”

D-Dimer to Predict the Clinical Outcomes in Patients with Mechanical Heart Valve Replacement During Oral Anticoagulation Therapy

“…22,23) A similar prognostic value was demonstrated in patients with cancer. 9,24,25) Therefore, D-dimer has the potential to predict all-cause events.…”

Significance of Coagulation and Fibrinolysis Markers for Benign and Malignant Soft Tissue Tumors

“…The generated plasmin induces a variety of proteolyses, including brin degradation. Moreover, plasmin not only cleaves extracellular matrices but also activates pro-MMPs [5]. Overexpression of uPAR in breast cancer enhanced tumor invasion, growth and metastasis [6].…”