Pre-Chemotherapy D-Dimer Levels as Predictors of Survival Outcomes in Advanced Gastric Cancer.

BACKGROUND Gastric cancer is a common malignancy of the digestive system. There are presently no efficacious indicators to evaluate its curative effect and prognosis. Increased plasma D-dimer was reported to have a very strong association with neoplasm in advanced stages and poor overall survival (OS) for some malignant tumors in morbidity. MATERIAL AND METHODS Using propensity score analysis, we examined the potential effect of pre-chemotherapy plasma D-dimer level (PDL) on OS and progression-free survival (PFS) in patients with advanced gastric cancer (AGC). We divided 134 patients with AGC into 2 groups: low pretreatment D-dimer (LPD) and high pretreatment D-dimer (HPD). Using propensity score analysis, one-to-one matches were performed for both groups to correct bias caused by different covariate distributions. RESULTS Before matching, patients with HPD had obviously lower median OS and PFS versus patients with LPD (months: 6.0 vs 8.7, P=0.015; 12.2 vs 15.1, P=0.037). Multivariate analysis indicated that PDL did not independently predict OS (hazard ratio [HR] 1.362, 95% confidence interval (CI) 0.851-2.181, P=0.198). In accordance with the first response evaluation, patients with PD had an increased mean D-dimer by 1.72 ug/mL compared with patients with PR and SD (P=0.006). There was a 15.1-month median OS for patients with LPD compared to 12.2 months for those with HPD (P=0.032). Multivariate analysis discovered that OS was independently predicted by PDL (HR of 1.711, 95% CI of 1.019 to 2.875, P=0.042), and the first response evaluation's mean D-dimer was raised by 1.91 ug/mL in patients with PD (P=0.039). CONCLUSIONS Gastric cancer patients with high D-dimer level had worse outcomes.