title: Prognostic significance of elevated D-dimer for survival in patients with sarcoma.
abstract: BACKGROUND
  Elevated levels of D-dimer, a marker for the systemic activation of the clotting and fibrinolysis, are frequently observed in patients with venous thromboembolism (VTE) and malignancy. We examined the prognostic significance of baseline plasma D-dimer levels for predicting survival in sarcoma.
  
  
  METHODS
  The study comprised of 45 patients receiving first-line chemotherapy for inoperable, high-risk for relapse, or metastatic disease. Plasma D-dimer levels was measured before chemotherapy. Univariate and multivariate analysis were performed for association between plasma D-dimer levels and baseline clinical characteristics in predicting survival.
  
  
  RESULTS
  D-dimer levels were elevated to ≥500 ng/mL in 53% (24 of 45 patients). Six of 45 patients (13%) developed VTE. The Kaplan-Meier analysis showed that the median survival for patients with VTE, metastatic disease, progression on chemotherapy, or D-dimer ≥500 ng/mL was shorter (log-rank test, P=0.012, 0.001, 0.034, and 0.015, respectively). The mortality rate for patients with D-dimer ≥500 ng/mL was higher (P<0.0001) than those with <500 ng/ml for both metastatic (100% vs. 62.5%) and nonmetastatic (58% vs. 31%) groups [median follow-up; 60 mo (range, 9 to 106 mo)]. Using stepwise proportional hazard model, D-dimer levels and metastasis status were independent significant predictors for survival [hazard ratios (95% confidence intervals), 4.24 (1.88-9.60), and 3.28 (1.42-7.58), respectively].
  
  
  CONCLUSIONS
  Elevated D-dimer levels have independent significant prognostic value for survival in sarcoma patients with both metastatic and nonmetastatic disease and may help identify high-risk patients for treatment decisions.
authors.affiliation: NYU School of Medicine, NY, USA.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Raj
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhou
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Bueso-Ramos
authors.forename: Vinod
authors.initials: V
authors.lastname: Ravi
authors.forename: Shreyaskumar
authors.initials: S
authors.lastname: Patel
authors.forename: Robert S
authors.initials: RS
authors.lastname: Benjamin
authors.forename: Saroj
authors.initials: S
authors.lastname: Vadhan-Raj
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001859:Bone Neoplasms / Q000378:metabolism / Q000401:mortality* / Q000473:pathology; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000378:metabolism / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D055503:Protein Multimerization; D012307:Risk Factors; D012509:Sarcoma / Q000378:metabolism / Q000401:mortality* / Q000473:pathology; D015996:Survival Rate; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D