Preoperative plasma D-dimer independently predicts survival in patients with pancreatic ductal adenocarcinoma undergoing radical resection

Abstract

Background Elevated plasma D-dimer levels have been reported as an unfavorable prognostic indicator in many solid tumors. However, there are limited relevant studies in pancreatic cancer patients following radical surgery, and the clinical significance remains controversial. The aim of this study was to investigate the clinical and prognostic significance of preoperative plasma D-dimer in patients with pancreatic ductal adenocarcinoma (PDAC) undergoing resection. Methods A retrospective analysis was performed on all patients who consecutively underwent radical surgery for PDAC by laparotomy or robotic surgery from December 2011 to December 2018. Baseline clinicopathologic characteristics, preoperative laboratory parameters, and follow-up information were collected. Univariate and multivariate analyses were performed to analyze the prognostic value of preoperative plasma D-dimer. Results Among 1351 patients, elevated preoperative plasma D-dimer levels (≥ 0.55 ng/mL) were found in 417 (30.9%) patients. Three hundred twelve (23.09%) underwent minimally invasive robotic pancreatectomy. The median overall survival (OS) of patients with elevated D-dimer levels was 6.3 months shorter than that of patients with normal D-dimer levels (15.0 months vs 21.3 months, p < 0.001). Multivariate analysis showed that elevated D-dimer levels independently predicted poorer OS (hazard ratio, 1.33; 95% confidence interval, 1.17-1.51, p < 0.001). Subgroup analysis demonstrated that D-dimer was a reliable prognostic factor in patients who underwent R0 resection. In addition, integration of D-dimer, carbohydrate antigen 19-9 (CA19-9), and NLR provided a better prognostic model for PDAC patients before operation. Conclusion An elevated preoperative plasma D-dimer level was a reliable independent prognostic factor for OS in patients with PDAC undergoing resection. Combination of D-dimer, CA19-9, and NLR can enhance the prognostic accuracy before operation.

Plasminogen deficiency suppresses pancreatic ductal adenocarcinoma disease progression

“…Specifically, patient studies focusing on the plasmin‐generated fibrin degradation product D‐dimer have indicated that elevated D‐dimer levels are associated with a worse overall survival for several solid tumor malignancies, including PDAC [ 39 , 40 ]. In one recent study of 1351 patients undergoing radical surgical resection of PDAC, high preoperative D‐dimer levels were strongly associated with a 6.3‐month reduction in overall survival (i.e., 15.0 vs 21.3 months) [ 41 ]. Intriguingly the relationship between PDAC disease severity and D‐dimer is not totally clear cut.…”

Simple Serum Pancreatic Ductal Adenocarcinoma (PDAC) Protein Biomarkers—Is There Anything in Sight?

“…The results showed that D-dimer was a reliable prognostic factor in patients who underwent R0 resection (p < 0.001). Moreover, an analysis of preoperative D-dimer, Ca19-9, and NLR values in PDAC patients receiving radical surgery enhanced the prognostic accuracy for OS [63]. The prognostication of patients with PDAC who undergo surgery might be predicted by assessing the D-dimer level as a promising and reliable marker.…”