Assessment of the association between D-dimer levels and clinicopathological characteristics of pancreatic cancer and its role in prognosis: a systematic review and meta-analysis

Abstract

Background: According to previous studies, D-dimer levels are associated with prognosis in patients with pancreatic cancer (PC). However, the current results are limited and controversial. Therefore, we conducted this meta-analysis to assess the relationship between D-dimer levels and the prognosis and pathological characteristics of patients with PC. Method: A computer search of PubMed, Embase, The Cochrane Library, Web Of Science, CBM, VIP, CNKI and Wanfang databases was conducted to identify available studies. The association between pre-treatment d -dimer levels and the prognosis of PC patients was assessed using a combined hazard ratio (HR) and 95% confidence interval (CI). The combined odds ratio (OR) and 95% confidence in CI were applied to assess the relationship between D-dimer levels and the pathological characteristics of patients with PC. For all of the statistical analyses, Stata 12.0 software was used. Result: A total of 13 studies involving 2777 patients were included in this meta-analysis. The results showed that elevated pre-treatment d -dimer levels were significantly associated with worsening OS (HR = 1.46 95% CI: 1.34-1.59; p＜0.001). We also performed subgroup analyses based on sample size, d -dimer threshold, follow-up time and source of HR to further validate the prognostic value of pre-treatment d -dimer levels in PC. In addition, according to the analysis, high pre-treatment d -dimer levels in PC patients were associated with late tumour stage (OR = 4.78, 95% CI 1.73-13.20, p＜0.005), larger tumours (OR = 1.72, 95% CI 1.25 ~ 2.35, p＜0.005) and distant metastases in tumours (OR = 5.06, 95% CI 2.45- 10.43, p＜0.005) were significantly associated. In contrast, other clinicopathological factors, including age, sex and lymph node metastasis, were not associated with d -dimer levels. Conclusion: High levels of d-dimer prior to treatment are associated with poor prognosis in patients with PC and are associated with more advanced tumour stage, larger tumours and the occurrence of distant metastases. Plasma d-dimer levels can be used as a biomarker of prognosis in patients with PC.