<p>Prognostic Value of the Preoperative Plasma D-Dimer Levels in Patients with Upper Tract Urothelial Carcinoma in a Retrospective Cohort Study</p>

Abstract

Elevated plasma D-dimer levels were thought to be associated with decreasing survival in various cancers. The relationship between plasma D-dimer levels and clinicopathology and the optimal D-dimer cutoff as a prognostic predictor has not been determined in patients with upper tract urothelial carcinoma (UTUC). We aimed to investigate the prognostic value of preoperative plasma D-dimer levels as a predictor of patient outcomes in UTUC following radical nephroureterectomy. Patients and Methods: We retrospectively reviewed data for 232 patients. The D-dimer cutoff value was set at 0.36 mg/L, and we used the Kaplan-Meier method and Cox's proportional hazards regression models to analyze the association between D-dimer levels and oncological outcomes. Multivariate Cox regression was used to develop a nomogram, which we evaluated for accuracy using a receiver operating characteristic curve, calibration plot, and decision curve analysis. Results: Plasma D-dimer levels ≥0.36 mg/L were significantly associated with advanced tumor status regarding size, location, hydronephrosis, tumor grade, lymph node involvement, grade, and stage (all p < 0.05). The Kaplan-Meier analysis showed that plasma D-dimer levels ≥0.36 mg/L predicted worse oncological outcomes vs levels <0.36 mg/L (all p < 0.001). Univariate and multivariate analyses showed that elevated preoperative plasma D-dimer level was an independent predictor of recurrence-free survival (hazard ratio (HR): 1.67, 95% confidence interval (CI): 1.07-2.63; p = 0.025), cancer-specific survival (HR: 2.34, 95% CI: 1.30-4.19; p = 0.004), and overall survival (HR: 1.98, 95% CI: 1.18-3.34; p = 0.010). We also developed a nomogram predicting 3-and 5-year overall survival probability. Conclusion: D-dimer levels may be a useful prognostic predictor of survival and improve risk stratification and precisely individualize treatment for patients with UTUC.

D-Dimer: A Potential Solution to Problems of Cancer Screening, Surveillance, and Prognosis Assessment

“…Chen et al reported that according to their Retrospective Cohort Study data, elevated plasma D-dimer levels predicted an increased risk of cancer recurrence and a worse prognosis in patients diagnosed with Upper Tract Urothelial Carcinoma, which is a rare urinary tumor with an unfavorable prognosis [ 19 ]. Their data found that plasma D-dimer levels ≥ 0.36 mg/L correlated with higher pathological T stage, tumor grade, and invasion of cancer to the blood vessels or lymphatics.…”

Evaluation of treatment for diffuse large B-cell lymphoma using plasma D-dimer levels

“…Patients with lower D-dimer levels may have inactive tumors and smaller tumor volumes. Elevated plasma D-dimer levels predict an increased risk of tumor recurrence and a poorer prognosis, according to data from a retrospective cohort analysis of patients with epithelial carcinoma of the upper urinary tract by Chen et al D-dimer levels have been shown to be useful in assessing the treatment and prognosis of a wide variety of malignancies 35 , including colorectal and uroepithelial malignancies 11,35 , as well as gastric 9,19,36 , lung 37 , breast 7,25 , cervical cancers 23 , and high-grade musculoskeletal sarcoma 38 .…”

Role of plasma fibrinogen and D-dimer as prognostic biomarkers in patients with non-muscle invasive bladder cancer

“…They also reported that pre-operative D-dimer levels can help in improving the risk stratification and a more accurate prediction of recurrence and survival. This can help in decision making for follow-up scheduling, administration of adjuvant therapies, and precise individualized treatment for patients [ 26 ]. In another study on prognostic value of preoperative inflammation-based predictors in patients with bladder carcinoma by Gui et al, they reported that high plasma fibrinogen levels are associated with a more aggressive clinical stage and plasma fibrinogen levels may be used to predict survival outcome of patients with bladder carcinoma [ 27 ].…”