| Objective: The purpose to investigate the relationship between level of plasma Ddimer and clinicopathological features and survival time in metastatic gastric cancer patients.Method: We retrospectively collected of the date of plasma D-dimer and clinicopathological characteristics in metastatic gastric cancer patients admitted in our department from March 2012 to March 2014,each including patients’ gender,age, ECOG score, pathological type, the diagnosis time, the death time and baseline CEA, PLT, FIB, D- dimer levels.The correlations between plasma baseline D-dimer levels and clinicopatholagical features and progonosis were analyzed,the value of D-dimer levels for overall survival was assessed.Results:1. A total of 121 patients were studied and followed up 102 cases in our research,follow-up rate 84.3%,72 patients were male and 30 were female(2.4:1);The mean age of the patients was 59 years.Sixty cases had a high plasma D-dimer level(>0.5mg/L) and 42 cases had a normal D-dimer level(≤0.5mg/L),59 patients had peritoneal dissemination and 43 cases had not found.2.Median overall survival time were 8.7 months(7.1-12.3). For 102 patients with normal and high D-dimer levels,the median survival time were 7.2 months(95% CI6.3- 8.2) and 10.2 months(95% CI 7.2-12.5),respectively(P < 0.05). Based on D-dimer level hierarchical analysis showed that,male patients with different level of D-dimer median survival time were 7.1 months(95% CI 5.9 8.2) and 5.9 months(95% CI 8.4 11.2), ECOG≥2 groups were 4.7 months(95% CI 3.7 5.8) and 3.7months(95% CI 6.0 10.0), peritoneal metastasis group were 6.3 months(95% CI5.3 7.3) and 5.3 months(95% CI 7.0 10.7), adenocarcinoma group were 6.9 months(95% CI 5.8 7.9) and 5.8 months(95% CI 7.8 10.7) months, respectively(P < 0.05).3. Single factor analysis showed that,the median OS in age≥ 60 years groups,poorly differentiated + signet ring cell carcinoma group, ECOG score≥2 group, D-dimer level > 0.5 mg/L group, FIB > 4.0 g/L group, CEA > 5.0 ng/dl group, were less than the other groups, respectively(P < 0.05).There were differences between the gender and the level of platelet groups of survival time,but they were not statistical significance(P > 0.05).Multiple factors analysis showed that the plasma D- dimer level, ECOG score and peritoneal metastasis were independent prognostic factors for metastatic gastric cancer patients.4. 86 patients underwent first-line chemotherapy, among them,23 case were effective, 29 cases were stable, 34 cases were progressive,The D-dimer levels were measured before and after combination chemotherapy,which were(1.99-1.03 mg/L)and(0.47-0.26 mg/L) in effective group, respectively(P < 0.001), were(1.27-0.98mg/L) and(1.15-0.82 mg/L) in stable group(P = 0.409), were(1.33-1.04 mg/L)and(2.21-0.85 mg/L) in the progress group,respectively(P = 0.027.Conclusion: The high D- dimer levels predict poor outcomes for metastatic gastric cancer patients, the plasma D – dimer level, ECOG score and peritoneal metastasis are independent prognostic factors.Screening people based on D-dimer level, may help us to understand the prophylactic anticoagulation effect on tumor progression and survival;The D-dimer level in effective chemotherapy group markly induced,to a certain extent, means plasma D-dimer can reflect the chemotherapy reactivity,but due to less sample size and the subsequent treatment,the results of the study needs further verification. |
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