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Open Access Highly Accessed Research article

Elevated levels of plasma D-dimer predict a worse outcome in patients with nasopharyngeal carcinoma

Wen-Hui Chen1, Lin-Quan Tang12, Feng-Wei Wang1, Chang-Peng Li1, Xiao-Peng Tian1, Xiao-Xia Huang1, Shi-Juan Mai1, Yi-Ji Liao1, Hai-Xia Deng1, Qiu-Yan Chen12, Huai Liu12, Lu Zhang12, Shan-Shan Guo12, Li-Ting Liu12, Shu-Mei Yan13, Chao-Feng Li14, Jing-Ping Zhang15, Qing Liu16, Xue-Wen Liu17, Li-Zhi Liu17, Hai-Qiang Mai12*, Mu-Sheng Zeng1* and Dan Xie1*

Author Affiliations

1 Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Centre for Cancer Medicine, Guangzhou 510060, P. R. China

2 Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China

3 Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China

4 Department of Information Technology, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China

5 Department of Clinical Laboratory, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China

6 Department of Statistics and Epidemiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China

7 Imaging Diagnostic and Interventional Centre, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China

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BMC Cancer 2014, 14:583  doi:10.1186/1471-2407-14-583

Published: 10 August 2014

Abstract

Background

Hemostatic alterations occur during the development of cancer. Plasma D-dimer is a hypercoagulability and fibrinolytic system marker that is increased in patients with various solid tumours. The aim of this study was to evaluate the hemostatic status of nasopharyngeal carcinoma (NPC) patients by assessing plasma D-dimer levels to investigate its value as a prognostic marker.

Methods

We retrospectively analysed 717 patients with nasopharyngeal carcinoma, and we applied Cox regression and log-rank tests to assess the association of D-dimer levels with disease-free survival (DFS), distant metastasis-free survival (DMFS), and overall survival (OS). D-dimer levels were measured using a quantitative D-dimer latex agglutination assay.

Results

Using the 3rd quartile values (0.8 μg/L) as the optimal cut-offs, we found that patients with high D-dimer levels have a shorter 3-year DFS, (79%, 95%CI (73.1–84.9)) vs. (69%, 95%CI (59.2–78.8)), DMFS (87%, 95%CI (83.1–90.9)) vs. (77%, 95%CI (69.2–84.8)), and overall survival (82%, 95%CI (76.1–87.9)) vs. (76%, 95%CI (66.2–85.8)). Multivariate analysis revealed that pre-treatment D-dimer levels and EBV DNA were significant independent factors for DFS, DMFS, and OS in NPC patients. Subgroup analyses indicated that the plasma D-dimer levels could effectively stratify patient prognosis for early cancer, advanced stage cancer, and patients with EBV DNA ≥4000 copies/ml.

Conclusions

High D-dimer levels were associated with poor disease-free survival, distant metastasis-free survival, overall survival, and increased risk of mortality in NPC patients. Prospective trials are required to assess the prognostic value of D-dimer levels.

Keywords:
Nasopharyngeal carcinoma; D-dimer; Survival