A retrospective analysis of plasma D-dimer dynamic variation in terminal stage cancer patients: implications for disease progression

Abstract

Elevated D-dimer is frequently found among cancer patients especially for advanced stage patients. Activation of the coagulation system and the fibrinolytic cascade are supposed to be associated with higher risk of invasion, metastases and worse outcome. The purpose of this study is to investigate the dynamic variation of plasma D-dimer and its relationship with other markers of the coagulation system including platelet counts, fibrinogen levels, prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) in terminal stage cancer patients. We designed a self-controlled study to compare plasma D-dimer dynamic variation from 0-4 weeks to 4-8 weeks before patients' death. The plasma D-dimer levels pointed an elevated tendency and revealed statistically significant difference as patients gradually near death. Prolonged PT, APTT and TT were found. D-dimer levels were positively correlated with PT, APTT and TT but showed negative correlation with platelet counts and fibrinogen levels. Plasma D-dimer levels gradually increased as terminal stage cancer patients approaching to death. Increasing D-dimer levels may predict worse outcome.

Keywords: D-dimer; cancer; disease progression; dynamic variation; terminal stage.

Figure 1

Dynamic variation of plasma D-dimer levels. Box plot of plasma D-dimer results from 4-8 weeks and 0-4 weeks before patients’ death. Box plots represent the range of data from the 25th to the 75th interquartile range, while the horizontal line in the middle of each box plot represents the median value. Circles and asterisks indicate outliers (1.5 x the interquartile range) and extreme values (3.0 x the interquartile range) outside the central box, respectively. The area below the horizontal line represents normal expected values established in our laboratory.

Figure 2

Dynamic variation of platelet counts. Box plot of platelet counts results from 4-8 weeks and 0-4 weeks before patients’ death. Box plots represent the range of data from the 25th to the 75th interquartile range, while the horizontal line in the middle of each box plot represents the median value. Circles and asterisks indicate outliers (1.5 x the interquartile range) and extreme values (3.0 x the interquartile range) outside the central box, respectively. The area below the horizontal line represents normal expected values established in our laboratory.

Figure 3

Dynamic variation of fibrinogen levels. Box plot of fibrinogen levels results from 4-8 weeks and 0-4 weeks before patients’ death. Box plots represent the range of data from the 25th to the 75th interquartile range, while the horizontal line in the middle of each box plot represents the median value. Circles and asterisks indicate outliers (1.5 x the interquartile range) and extreme values (3.0 x the interquartile range) outside the central box, respectively. The area below the horizontal line represents normal expected values established in our laboratory.