Prognostic role of preoperative platelet, fibrinogen, and D‐dimer levels in patients with non‐small cell lung cancer: A multicenter prospective study

Abstract

BackgroundThe relationships between coagulation factors and non‐small cell lung cancer (NSCLC) prognosis have been intensively studied. However, no previous study has investigated the combined effects of preoperative platelet (PLT), fibrinogen (FIB), and D‐dimer (D‐D) levels on the prognosis of NSCLC.MethodsA multicenter prospective study was conducted over seven hospitals. A total of 395 patients diagnosed with operable NSCLC for the first time were included and followed‐up until disease progression or the end of the study. Baseline demographic and clinicopathological information, and preoperative coagulation test results were collected for each patient. Univariate and multilevel survival analyses were conducted using Cox regression and shared frailty models.ResultsMultilevel analyses revealed that there was a marginally significant association between elevated PLT level (> 215 × 109/L) and unfavorable progression‐free survival (PFS) (hazard ratio 2.42, P = 0.05), whereas preoperative FIB and D‐D were not significant prognostic factors for PFS (P = 0.31 and 0.30, respectively). Compared to patients with one elevation of the three coagulation factors, patients with at least two elevations of the three factors had a significantly higher risk of cancer progression (hazard ratio 4.62, P = 0.02).ConclusionThe number of elevated preoperative coagulation factors may have a significant effect on PFS and could be used to predict the prognosis of NSCLC patients after surgery. Future studies are warranted to further investigate the interactions between these three coagulation factors.

Dynamics of D‐dimer in non‐small cell lung cancer patients receiving radical surgery and its association with postoperative venous thromboembolism

“…24 D-dimer levels were higher than baseline in patients who developed VTE after surgery, and studies have shown that preoperative levels of D-dimer had an impact on survival of NSCLC patients. 16 However, it seems irresponsible to omit the fluctuations of D-dimer levels after surgery. Actually, increased attention is being paid to long-term D-dimer level changes and the relationship with VTE, 36 and in our experience, a more meticulous tracking of D-dimer levels can depict a more detailed hematological profile, and can be achieved by following the level changes closely in adjacent days instead of at subsequent relatively longer intervals.…”

“…13 D-dimer, as an end production of fibrin degradation, is a strong indicator of VTE, which also predicts prognosis and long-term survival after antitumor therapy. [14][15][16][17] Many prediction models that integrated D-dimer as a necessary index have been developed to predict the incidence of cancer-associated VTE and to stratify patients by different degrees of risk. [18][19][20][21][22] However, almost every model used preoperative D-dimer test results as a stationary index, and may therefore have missed the dynamic trend of D-dimer concentration after surgery which then causes bias when these models are employed.…”

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

“…Plasma D-dimer is the product of cross-linked fibrin degradation by plasmin-induced fibrinolytic activity, and this marker has been widely used as a useful indicator of hemostasis and fibrinolysis activation. Elevated preoperative plasma D-dimer levels have been reported to be an unfavorable prognostic factor in various malignancies, such as lung cancers, 6,15 digestive tract cancers, 16 urological cancers 10,11,17 and soft tissue sarcomas. 5,7 The mechanism underlying the association between elevated plasma D-dimer levels and malignancy remains speculative.…”

“…[2][3][4] Preoperative factors, namely body mass index, advanced age, delayed surgery, hydronephrosis, tumor location, and neutrophil-lymphocyte ratio (NLR) are associated with poor prognosis. 3 Several studies have demonstrated an association between malignancy and hemostasis biomarkers 5,6 with tumors associated with high levels of coagulation markers (fibrinogen) and thrombogenesis markers (D-dimer). D-dimer is a cleavage product of fibrin, which is produced by plasmin-induced fibrinolysis, 7 and this biomarker indicates the activation of hemostasis and fibrinolysis.…”

“…Elevated plasma D-dimer levels may be associated with disseminated intravascular coagulation, pregnancy, infectious diseases, trauma, surgery, and venous thromboembolism. 8 Although elevated circulating D-dimer levels are related to various cancers, such as lung, breast, prostate, and bladder cancer, 6,[9][10][11] the relationship between this hemostatic biomarker and UTUC survival outcomes is unclear. Therefore, the purpose of the current study was to investigate the prognostic value of preoperative plasma D-dimer levels in UTUC.…”