title: Elevated levels of plasma D-dimer predict a worse outcome in patients with nasopharyngeal carcinoma.
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.
authors.forename: Wen-Hui
authors.initials: WH
authors.lastname: Chen
authors.forename: Lin-Quan
authors.initials: LQ
authors.lastname: Tang
authors.forename: Feng-Wei
authors.initials: FW
authors.lastname: Wang
authors.forename: Chang-Peng
authors.initials: CP
authors.lastname: Li
authors.forename: Xiao-Peng
authors.initials: XP
authors.lastname: Tian
authors.forename: Xiao-Xia
authors.initials: XX
authors.lastname: Huang
authors.forename: Shi-Juan
authors.initials: SJ
authors.lastname: Mai
authors.forename: Yi-Ji
authors.initials: YJ
authors.lastname: Liao
authors.forename: Hai-Xia
authors.initials: HX
authors.lastname: Deng
authors.forename: Qiu-Yan
authors.initials: QY
authors.lastname: Chen
authors.forename: Huai
authors.initials: H
authors.lastname: Liu
authors.forename: Lu
authors.initials: L
authors.lastname: Zhang
authors.forename: Shan-Shan
authors.initials: SS
authors.lastname: Guo
authors.forename: Li-Ting
authors.initials: LT
authors.lastname: Liu
authors.forename: Shu-Mei
authors.initials: SM
authors.lastname: Yan
authors.forename: Chao-Feng
authors.initials: CF
authors.lastname: Li
authors.forename: Jing-Ping
authors.initials: JP
authors.lastname: Zhang
authors.forename: Qing
authors.initials: Q
authors.lastname: Liu
authors.forename: Xue-Wen
authors.initials: XW
authors.lastname: Liu
authors.forename: Li-Zhi
authors.initials: LZ
authors.lastname: Liu
authors.affiliation: 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. maihq@sysucc.org.cn.
authors.forename: Hai-Qiang
authors.initials: HQ
authors.lastname: Mai
authors.forename: Mu-Sheng
authors.initials: MS
authors.lastname: Zeng
authors.forename: Dan
authors.initials: D
authors.lastname: Xie
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma; D059248:Chemoradiotherapy; D004279:DNA, Viral / Q000097:blood; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D004854:Herpesvirus 4, Human / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D016016:Proportional Hazards Models; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D004279:DNA, Viral; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
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