Predictive value of the plasma D-dimer levels on stage and response to chemotherapy of the pancreatic cancer

Objective:To investigate the predictive value of the plasma D-dimer levels on stage and response to chemotherapy of the pancreatic cancer (PC).
Methods:The retrospective cross-sectional study was conducted. The clinicopathological data of 212 PC patients who were admitted to the Fudan University Shanghai Cancer Center between December 2016 and May 2017 were collected. Plasma D-dimer levels of 212 patients were measured, and relationship between plasma D-dimer levels and clinicopathological features or response to chemotherapy were analyzed. Observation indicators: (1) relationship between clinicopathological features and positive rate of plasma D-dimer before treatment; (2) relationship between response to chemotherapy and plasma D-dimer levels; (3) follow-up and survival situations. Follow-up using telephone interview was performed to detect survival of patients up to January 2018. Comparisons of count data were analyzed using chi-square test. Measurement data with skewed distribution were described as M (range).
Results:(1) Relationship between clinicopathological features and positive rate of plasma D-dimer before treatment: positive rate of plasma D-dimer before treatment was respectively 18.37%(9/49), 43.64%(24/55), 53.85%(28/52), 80.36%(45/56) in patients with stage Ⅰ-ⅡA, ⅡB, Ⅲ and Ⅳ of TNM staging and 43.59%(17/39), 24.62%(16/65) in patients with low-differentiated tumor and high- and moderate-differentiated tumor, with statistically significantly differences (x²=41.454, 4.051, P<0.05). (2) Relationship between response to chemotherapy and plasma D-dimer levels: of 212 PC patients, 108 received pathological diagnosis by endoscopic ultrasonography or liver puncture, and then underwent 4-6 cycles chemotherapy with gemcitabine. Of 108 patients, response to chemotherapy of 59 patients was partial remission or stable disease, plasma D-dimer level before treatment was increased in 39 patients (28 with reduced plasma D-dimer level after treatment) and normal in 20 patients; response to chemotherapy of 49 patients was progressive disease, plasma D-dimer level before treatment was increased in 34 patients (8 with reduced plasma D-dimer level after treatment) and normal in 15 patients. There was no statistically significant difference in proportion of patients with increased plasma D-dimer level before treatment (x²=0.132, P>0.05), and there was a statistically significant difference in proportion of patients with reduced plasma D-dimer level after treatment (x²=16.929, P<0.05). (3) Follow-up and survival situations: 212 patients were followed up for 3.5-12.0 months, with a median time of 7.5 months. During the follow-up, 7 patients died and 205 had survival.
Conclusions:The plasma D-dimer level is significantly associated with TNM staging of the PC, tumor differentiation and response to chemotherapy.