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- Title
Postoperative D-dimer elevation affects tumor recurrence and the long-term survival in gastric cancer patients who undergo gastrectomy.
- Authors
Hara, Kentaro; Aoyama, Toru; Hayashi, Tsutomu; Nakazono, Masato; Nagasawa, Shinsuke; Shimoda, Yota; Kumazu, Yuta; Numata, Masakatsu; Yamada, Takanobu; Tamagawa, Hiroshi; Shiozawa, Manabu; Morinaga, Soichiro; Yukawa, Norio; Rino, Yasushi; Masuda, Munetaka; Ogata, Takashi; Oshima, Takashi
- Abstract
Introduction: We retrospectively evaluated the blood coagulation activity using the D-dimer level in the early period after gastrectomy and investigated whether postoperative hypercoagulation affects tumor recurrence and long-term survival in gastric cancer patients. Methods: The study involved 650 patients who underwent curative resection for gastric cancer at Kanagawa Cancer Center between July 2009 and July 2013. They were divided into a low-D-dimer group (LD group) and high-D-dimer group (HD group) according to the median D-dimer level on postoperative day (POD) 7. The risk factors for overall survival (OS) and relapse-free survival (RFS) were identified. Results: Of the 448 enrolled patients, 218 were classified into the LD group and 230 into the HD group. The 5-year OS rates after surgery were 90.8% and 81.3% in the LD and HD groups, respectively (p < 0.001). The 5-year RFS rates after surgery were 89.9% and 76.1% in the LD and HD groups, respectively (p < 0.001). A high D-dimer level on POD 7 (≥ 4.9 μg/ml) was identified as an independent predictive factor for both the OS (hazard ratio [HR] 1.955, 95% confidence interval [CI] 1.158–3.303, p = 0.012) and RFS (HR 2.182, 95% CI 1.327–3.589, p = 0.002). Furthermore, hematological recurrence was significantly more frequent in the HD group than in the LD group (p = 0.014). Conclusion: A high D-dimer level on POD 7 may predict tumor recurrence and the long-term survival in patients who undergo gastrectomy for locally advanced gastric cancer. Patients with an elevated postoperative D-dimer level need careful observation and diagnostic imaging to timely detect tumor recurrence.
- Subjects
STOMACH cancer; CANCER patients; BLOOD coagulation; FIBRIN fragment D; GASTRECTOMY; HEMODIAFILTRATION
- Publication
International Journal of Clinical Oncology, 2020, Vol 25, Issue 4, p584
- ISSN
1341-9625
- Publication type
Article
- DOI
10.1007/s10147-019-01603-x