High plasma d-dimer level is associated with decreased survival in patients with lung cancer

Aims: An elevated plasma D-dimer level indicates the activation of coagulation and fibrinolysis. In the present study, we investigated the association of pre-treatment haemostatic parameters (D-dimer, fibrinogen and prothrombin fragment 1 + 2) with clinicopathological parameters and outcome in patients with lung cancer. Materials and methods: Plasma levels Of D-dimer and other parameters were measured in 78 evaluable patients with lung cancer (60 non-small cell lung cancers, 18 small cell lung cancers). At diagnosis, 35 patients (44.9%) were locally advanced stage (IIIA/B) and 43 patients (55.1%) had metastatic disease (IV). Multivariate statistical analysis was carried out using Cox's proportional hazards model. The receiver operating characteristic curve was used to determine the cutoff values for D-dimer, fibrinogen and prothrombin fragment 1 + 2. Results: The median survival for all patients was 264 days (95% confidence interval 200-328 days). A significant association between the plasma levels Of D-dimer and the response to chemotherapy was observed (P = 0.03). With the univariate analysis, tumour stage, pre-treatment plasma levels Of D-dimer, fibrinogen, platelet count, lactate dehydrogenase concentration and Karnofsky performance status were predictive for survival. With the multivariate analysis (P <= 0.11), the plasma level Of D-dimer (P < 0.001), tumour stage (P = 0.01) and Karnofsky performance status (P = 0.02) were identified as independent predictive factors. The median survival times were 405 days (95% confidence interval 165-644 days) and 207 days (95% confidence interval 146-267 days, P < 0.001), respectively, for patients with a low D-dimer level (<= 0.65 mu g/ml) and a high D-dimer level (> 0.65 mu g/ml). Conclusions: Elevated plasma levels Of D-dimer in patients with lung cancer are associated with decreased survival and a poor response to treatment. Pre-treatment for the D-dimer level may be useful in the prediction of survival and the response to treatment.