title: Is circulating D-dimer level a better prognostic indicator than CEA in resectable colorectal cancer? Our experience on 199 cases.
abstract: OBJECTIVE
  To evaluate the clinical impact of D-dimer (DD) as a tumor marker in patients with colorectal cancer (CRC). The prognostic value of preoperative DD measurement was assessed in relation to carcinoembryonic antigen (CEA) levels.
  
  
  METHODS
  DD and CEA levels were measured preoperatively in 199 patients who underwent resection for CRC and the results were analyzed statistically.
  
  
  RESULTS
  The preoperative mean (± SD) levels of DD and CEA were 347.5 (± 940.1) ng/mL and 106.4 (± 1099.2) ng/mL. The DD level was significantly correlated with the nature of surgery (emergency vs. elective; p=0.002), presence of residual tumor (R1-2 vs R0; p=0.037), and tumor diameter (p<0.001). Conversely, DD was not correlated with tumor grade, pT, pN and M stages, and stage according to the Dukes classification. The 5-year survival rates were 80% and 64% for patients with negative and positive DD values, respectively (p=0.156). CEA was significantly related to all major prognostic factors (resection category, pT, pN and M stages as well as Dukes stage). A significantly worse prognosis was observed for patients with positive CEA levels. Multivariate analysis confirmed CEA as an independent prognostic factor (p=0.005), whilst DD was not (p=0.796).
  
  
  CONCLUSIONS
  The possible clinical usefulness of preoperative assessment of DD suggested by previous studies has not been confirmed by our data. CEA was confirmed to be the most reliable and valid indicator of prognosis.
authors.affiliation: Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena and ITT, Istituto Toscano Tumori, Siena, Italy. pedrazzani@unisi.it
authors.forename: Corrado
authors.initials: C
authors.lastname: Pedrazzani
authors.forename: Guido
authors.initials: G
authors.lastname: Cerullo
authors.forename: Daniele
authors.initials: D
authors.lastname: Marrelli
authors.forename: Eduardo
authors.initials: E
authors.lastname: Fernandes
authors.forename: Filippo
authors.initials: F
authors.lastname: Carlucci
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corso
authors.forename: Francesca
authors.initials: F
authors.lastname: Bettarini
authors.forename: Alfonso
authors.initials: A
authors.lastname: De Stefano
authors.forename: Franco
authors.initials: F
authors.lastname: Roviello
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D002272:Carcinoembryonic Antigen / Q000032:analysis*; D003110:Colonic Neoplasms / Q000097:blood* / Q000401:mortality / Q000601:surgery; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009928:Organ Specificity; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000097:blood* / Q000401:mortality / Q000601:surgery; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D