The Relationship Between Plasma D-dimer And The Efficacy And Prognosis Of Advanced Gastric Cancer

Background and objective:Gastric cancer is the fifth most common cancer in the world and ranks third in cancer-related causes of death.Many patients have distant metastases at the initial diagnosis.For these patients,systemic chemotherapy to control the condition is one of the options,but the prognosis is poor.Gastric cancer has no specific highly sensitive biomarkers that could indicate the prognosis or predict therapeutic efficacy.For postoperative patients,detailed TNM stage after surgery is most important for judging the prognosis.But for patients with metastases or relapses disease,postoperative TNM stage is not associated with prognosis.At present,some tumor markers(e.g CEA)are widely used clinically to indicate the prognosis of patients and to predict therapeutic efficacy.However,at present,limited data are available.The vast majority of tumor-related deaths are due to disease progression,but 10% to 20% of deaths are associated with thrombosis.The occurrence of thrombosis in cancer patients is related to hypercoagulability,endothelial damage,and blood flow viscosity.The D-dimer is a cross-linked fibrin degradation product,and its elevation is considered to be a hypercoagulable state or a secondary fibrinolytic state.In patients with gastric cancer,even without thrombosis,activation of the coagulation system is associated with tumor progression,angiogenesis,and metastatic disease.Therefore,the relationship between the elevation of D-dimer and the death caused by tumor progression deserves our further study.The purpose of this study is to investigate the role of D-dimer in predicting prognosis and short-term efficacy for patients with advanced gastric cancer and treated by chemotherapy.Methods:Patients of this study were diagonosed with advanced gastric cancer and treated from January 2013 to December 2015 in Jiangsu Cancer Hospital.All patients received at least 2 cycles of palliative chemotherapy,and patients were evaluated for response according to the Response Evaluation Criteria in Solid Tumors(RECIST)criteria.D-dimer was measured before chemotherapy.When the first response evaluation was performed,D-dimer was re-examined.While measuring the D-dimer value,CEA value was also measured and recorded.All patients were followed up and their survival time was documented.Experimental data were analyzed using SPSS20.0 statistical software.Results:1.In the first evaluation of response,Eighty-four patients got PR,D-dimer showed a decreasing trend after treatment compared with that before treatment(p=0.691).One hundred and forty patients were assessed as SD,D-dimer also decrease after chemotherapy(p=0.152).Eighty-one patients got a PD after treatment,and D-dimer increased after treatment(p<0.001).2.The relationship between clinical factors and survival time of advanced gastric cancer was analyzed by Kaplan-Meier method.The results showed that(1)The median survival time of patients over 60 years of age was shorter than that of patients younger than 60 years(14.8 vs 16.6 months,p=0.210).(2)No significant difference in median survival was found between men and women(p=0.841).(3)The median survival of patients with poorly differentiated cancer was shorter than thosewith moderate differentiation(14.8 vs 18.7 months,p=0.008).(4)Patients with D-dimer ≤0.55 mg/L before treatment had longer median survival than those with D-dimer>0.55 mg/L(17.8 vs 13.7 months,p=0.044).(5)The median survival time was longer in patients who were effectively treated than those who were not(16.4 vs.14.8 months,p=0.344).(6)No significant difference was found in survival time between patients with normal CEA and those with elevated CEA(p=0.220).(7)The survival time of patients with liver metastases was shorter than that of patients with metastases from other sites(12.4 vs.16.6 months,p=0.006).A multivariate COX survival analysis showed that pre-treatment high D-dimer levels,poor tissue differentiation,and hepatic metastasis were independent prognostic factors for this cohort of patients with advanced gastric cancer.Conclusion:This study shows that D-dimer could be used as a biomarker for predicting the short-term response and prognosis for patients with advanced gastric cancer and treated by chemotherapy.