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. 2019 Jul;12(7):996-1004.
doi: 10.1016/j.tranon.2019.04.011. Epub 2019 May 21.

Preoperative D-dimer and Gamma-Glutamyltranspeptidase Predict Major Complications and Survival in Colorectal Liver Metastases Patients After Resection

Qichen Chen  1 , Hong Zhao  1 , Jianxiong Wu  1 , Jianqiang Cai  1 , Cong Li  2 , Jianjun Zhao  1 , Xinyu Bi  1 , Zhiyu Li  1 , Zhen Huang  1 , Yefan Zhang  1 , Wei Cui  3 , Jianguo Zhou  4
Affiliations

Preoperative D-dimer and Gamma-Glutamyltranspeptidase Predict Major Complications and Survival in Colorectal Liver Metastases Patients After Resection

Qichen Chen et al. Transl Oncol. 2019 Jul.

Abstract

Objectives: To investigate the predictive value of the pre-operative D-dimer and gamma-glutamyltranspeptidase (GGT) for the prognosis in colorectal liver metastases (CRLM) patients after hepatic resection.

Methods: Two hundred and ninety-two patients between December 2008 and December 2016 and 101 patients at our center from January 2017 to December 2018 were selected as a training set and validation set, respectively. The combination of the pre-operative D-dimer and GGT status (CPDG score) was scored as follows: elevated D-dimer levels with elevated GGT levels was allocated a score of 2, decreased D-dimer levels with decreased GGT levels was allocated a score of 0, and all other combinations were allocated a score of 1. In the training set, a logistic regression was applied to explore potential predictors of major postoperative complications. A Cox proportional hazards analysis was used to analyze survival. We further verified our findings in the validation set.

Results: Major complications occurred in 43 (14.7%) and 25 (24.8%) patients in the training set and validation set, respectively. In the training set, multivariate analysis showed that elevated GGT levels and elevated D-dimer levels independently predicted major complications respectively. In the multivariate analyses, elevated pre-operative D-dimer levels remained independently associated with decreased overall survival (OS) (hazard ratio [HR] = 1.751, 95% confidence interval [CI]: 1.139-2.691, P = .01). The CPDG score was an independent prognostic factor for major complications and OS in the multivariate analyses. The predictive ability of the CPDG score was higher than either factor alone. A Kaplan-Meier survival analysis showed that compared with patients with CPDG score = 1 or CPDG score = 0, patients with a CPDG score = 2 had worsened OS. Furthermore, for OS comparisons, the differences between any two groups were significant. In the validation set, elevated GGT and D-dimer were also suggested to predict worse progression-free survival (PFS) and to be independently associated with major complications.

Conclusions: The pre-operative D-dimer levels, GGT levels and CPDG score are reliable biomarkers to predict post-operative major complications or survival in CRLM patients after hepatic resection, which make it useful for CRLM patients in guiding surveillance approaches and prognosis assessments.

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Figures

Figure 1
Figure 1
A. Survival analysis of D-dimer <0.285 mg/L versus D-dimer ≥0.285 mg/L in the training set. B. PFS analysis of D-dimer <0.285 mg/L versus D-dimer ≥0.285 mg/L in the training set. C. Survival analysis of GGT <30.5 U/L versus GGT ≥30.5 U/L in the training set. D. PFS analysis of GGT <30.5 U/L versus GGT ≥30.5 U/L in the training set.
Figure 2
Figure 2
A. Survival analysis of CPDG = 0 versus CPDG = 1 versus CPDG = 2 in the training set . B. PFS analysis of CPDG = 0 versus CPDG =1 versus CPDG = 2 in the training set.
Figure 3
Figure 3
A. OS analysis of D-dimer <0.285 mg/L versus D-dimer ≥0.285 mg/L in the validation set. B. OS analysis of GGT<30.5 U/L versus GGT ≥30.5 U/L in the validation set. C. OS analysis of CPDG = 0 versus CPDG =1 versus CPDG = 2 in the validation set.
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