The prognostic value of D-dimer in lung cancer.
OBJECTIVE
Activation of coagulation and fibrinolysis is frequently encountered among cancer patients. Such tumors are supposed to be associated with higher risk of invasion, metastases and eventually worse outcome. The aim of this study is to explore the prognostic value of blood coagulation tests for lung cancer patients.


METHODS
Between 2009 and 2012, 72 newly diagnosed patients with lung cancer and 40 healthy subjects as control group were included in this prospective study. Patients were staged according to the seventh edition of the tumor, node, metastasis (TNM) classification. The treatment responses of patients were evaluated according to the World Health Organization (WHO) criteria. We measured plasma D-dimer level, activated partial thromboplastin time (APTT), prothrombin time (PT), international normalized ratio (INR), lactate dehhydrogenase (LDH), hemoglobin (Hb), platelet (Plt), white blood cells (WBC) count before, during and after chemotherapy. We investigated association of the results with stage and histologic type of the disease, as well as with response to therapy and survival in lung cancer patients.


RESULTS
The median D-dimer, PT and INR levels of the patients with lung cancer were significantly higher than in the control group (P = 0,000). D-dimer, APTT, PT, INR, LDH levels after four cycles of treatment were significantly lower in responders than in nonresponders (P = 0,000). Plasma D-dimer levels were evaluated according to histopathological type and stage of diseases; D-dimer level was found significantly higher in metastatic disease (P < 0,5) and significantly lower in small cell lung cancer (SCLC) (P < 0,05). The mean follow-up was 574,14 ± 463,48 days. The mean survival was 750,866 ± 74,857 days (95% CI: 604,147 - 897,586). After second and fourth cycles of treatment, the plasma D-dimer, APTT, and LDH levels were higher in mortality group than in survival group (P = 0,000). After four cycles of treatment, the mean survival of the patients with serum D-dimer level above and below 1900 ng/mL was found to be significantly different (P = 0,000).


CONCLUSIONS
The results suggest that determination of D-dimer plasma levels that is an inexpensive, easy and non invasive method may be useful in predicting clinical outcome, survival and treatment response of patients with lung cancer.
Department of Respiratory Diseases, Chest Disease and Surgery Training and Research Hospital, Izmir, Turkey.
Tuba
T
İnal
Department of Respiratory Diseases, Chest Disease and Surgery Training and Research Hospital, Izmir, Turkey.
Ceyda
C
Anar
Department of Respiratory Diseases, Chest Disease and Surgery Training and Research Hospital, Izmir, Turkey.
Gülru
G
Polat
Department of Respiratory Diseases, Chest Disease and Surgery Training and Research Hospital, Izmir, Turkey.
İpek
İ
Ünsal
Department of Respiratory Diseases, Chest Disease and Surgery Training and Research Hospital, Izmir, Turkey.
Hüseyin
H
Halilçolar
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001772:Blood Cell Count; D001780:Blood Coagulation Tests; D002277:Carcinoma / Q000097:blood* / Q000401:mortality / Q000473:pathology*; D016022:Case-Control Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
D-dimer; lung cancer; prognosis; survival