title: D-dimer: not just an indicator of venous thrombosis but a predictor of asymptomatic hematogenous metastasis in gastric cancer patients.
abstract: BACKGROUND
  Plasma D-dimer levels have been shown to be high in advanced tumor stage patients and can be used to predict clinical outcome in cancer patients. As most advanced tumor stage patients exhibit asymptomatic metastasis, which contributes to early tumor recurrence after surgery, we hypothesized that plasma D-dimer levels can be used to predict patients with potential metastasis.
  
  
  METHODS
  We enrolled 1042 primary gastric cancer patients in three multiple cancer centers in Northwest China and examined plasma D-dimer levels using the latex-enhanced immunoturbidimetric assay (LEIA) method. Plasma D-dimer levels were compared with the clinicopathological characteristics in this large-scale case-control study with follow up. We also performed regular follow-up studies for 395 patients to analyze the 2-year survival rate and early tumor recurrence.
  
  
  RESULTS
  In this large-scale clinical study, we found that plasma D-dimer levels were increased in patients with distant metastasis and especially hematogenous metastasis patients. The cut-off value of the D-dimer levels was determined to be 1.5 mg/ml based on the ROC curve, and the sensitivity and specificity for metastasis prediction were 61.9% and 86.6%, respectively. Additionally, patients with high D-dimer levels displayed early tumor recurrence and poor outcome during the follow-up study.
  
  
  CONCLUSIONS
  Plasma D-dimer may represent an easy to measure and lower cost marker for the testing of gastric cancer patients to predict asymptomatic hematogenous metastasis.
authors.affiliation: Department of Oncology Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
authors.forename: Dongmei
authors.initials: D
authors.lastname: Diao
authors.affiliation: Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Oncology Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Cheng
authors.affiliation: Department of Oncology Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Oncology Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Guo
authors.affiliation: Department of Oncology Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
authors.forename: Yongchun
authors.initials: Y
authors.lastname: Song
authors.affiliation: Department of Oncology Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Zhu
authors.affiliation: Department of Oncology Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
authors.forename: Kang
authors.initials: K
authors.lastname: Li
authors.affiliation: Department of Oncology Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
authors.forename: Di
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Oncology Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
authors.forename: Chengxue
authors.initials: C
authors.lastname: Dang
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D016022:Case-Control Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis*; D013274:Stomach Neoplasms / Q000473:pathology*; D016019:Survival Analysis; D020246:Venous Thrombosis / Q000175:diagnosis*
chemical_list: D014408:Biomarkers, Tumor; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D