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Meta-Analysis
. 2021 Apr 16;100(15):e25447.
doi: 10.1097/MD.0000000000025447.

High pretreatment D-dimer level is an independent unfavorable prognostic factor of small cell lung cancer: A systematic review and meta-analysis

Han-Yu Deng  1 , Xing-Sheng Ma  2 , Jie Zhou  1 , Ru-Lan Wang  1 , Rui Jiang  1 , Xiao-Ming Qiu  1
Affiliations
Meta-Analysis

High pretreatment D-dimer level is an independent unfavorable prognostic factor of small cell lung cancer: A systematic review and meta-analysis

Han-Yu Deng et al. Medicine (Baltimore). .

Abstract

Background: High pretreatment level of D-dimer in small cell lung cancer (SCLC) is commonly encountered, but the impact of high pretreatment D-dimer level on the prognosis of SCLC patients remains undetermined. Therefore, we conducted this meta-analysis focusing specifically on the prognostic value of high pretreatment D-dimer level in SCLC patients comprehensively.

Methods: We searched systematically in PubMed, Embase, and Web of Science for relevant studies published before January 28, 2019. Outcomes including 1-year overall survival (OS), progression-free survival (PFS) rates, and hazard ratios (HRs) of OS and PFS from multivariate analysis were extracted and analyzed.

Results: A total of 5 cohort studies consisting of 813 SCLC patients (473 patients with high pretreatment level of D-dimer and 340 with normal level of D-dimer) were finally included for meta-analysis. We found that patients with high pretreatment level of D-dimer had significantly shorter 1-year OS (47.6% vs 79.9%; fixed effects: risk ratio [RR] = 2.506; 95% confidence interval [CI] = [1.948, 3.224]; P < .001) and PFS (15.8% vs 34.0%; random effects: RR = 1.294; 95% CI = [1.060, 1.579]; P = .011) rates than those with normal level of D-dimer. Moreover, high pretreatment D-dimer level was further proved to remain as an unfavorable predictor of OS (fixed effects: HR = 1.865; 95% CI = [1.469, 2.367]; P < .001; I2 = 7.6%) and PFS (fixed effects: HR = 1.513; 95% CI = [1.183, 1.936]; P = .001; I2 = 0.0%) in patients with SCLC.

Conclusion: High pretreatment level of D-dimer was found to be an independent unfavorable prognostic factor in SCLC patients. However, more studies with sufficient adjustment for confounding factors are encouraged to confirm our conclusions.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
PRISMA flow diagram showing the progress of study evaluation throughout the review.
Figure 2
Figure 2
Forest plots of (A): 1-year overall survival rate, and (B): 1-year progression-free survival rate.
Figure 3
Figure 3
Forest plots of (A): overall survival, and (B): progression-free survival.
Figure 4
Figure 4
Sensitivity analysis for (A): 1-year overall survival rate, and (B): 1-year progression-free survival rate.
Figure 5
Figure 5
Funnel plot of the included studies for analysis of 1-year overall survival rate. Begg test: P = .487; Egger test: P = .069. Note: because only 4 studies reported 1-year overall survival rates and as a result, in the publication analysis, there were only 4 points in the funnel plot.
See this image and copyright information in PMC

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