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High D-dimer levels are associated with poor prognosis in cancer patients
Haematologica. 2012 August; 97(8): 1158–1164.
Cihan Ay, Daniela Dunkler, Robert Pirker, Johannes Thaler, Peter Quehenberger, Oswald Wagner, Christoph Zielinski, and Ingrid Pabinger.

Des taux élevés de D-dimères seraient donc associés à augmentation du risque de mortalité chez les patients cancéreux. Le caractère prédictif d'un mauvais pronostic est indépendant de la survenue d'une complication thromboembolique veineuse et est indépendante de la présence ou non de métastases. La mesure du taux des D-Dimères pourrait constituer un test prédictif et sa mesure séquentielle chez des patients pourrait permettre d’évaluer l’efficacité des traitements anti cancéreux ; ces données pourraient également être un argument pour l’utilisation concomitante de traitements antithrombotiques. A suivre....

Voir également : Thrombose veineuse la valeur prédictive négative des D-dimères est confirmée [Lire]

Background
Systemic activation of hemostasis is frequently observed in cancer patients, even in the absence of thrombosis. Moreover, this activation has been implicated in tumor progression, angiogenesis and metastatic spread. Increased levels of D-dimer, which is a degradation product of cross-linked fibrin, indicate a global activation of hemostasis and fibrinolysis.

Design and Methods
In a prospective and observational cohort study, we assessed the prognostic value of D-dimer levels for overall survival and mortality risk in 1178 cancer patients included in the Vienna Cancer and Thrombosis Study (CATS). Patients were followed over 2 years at regular intervals until occurrence of symptomatic venous thromboembolism or death. D-dimer levels were measured with a quantitative D-dimer latex agglutination assay

Results
The main solid tumors were malignancies of the lung (n=182), breast (n=157), lower gastrointestinal tract (n=133), pancreas (n=74), stomach (n=50), kidney (n=37), prostate (n=133), and brain (n=148); 201 of the patients had hematologic malignancies; 63 had other tumors. During a median follow-up of 731 days, 460 (39.0%) patients died. The overall survival probabilities for patients with D-dimer levels categorized into four groups based on the 1st, 2nd and 3rd quartiles of the D-dimer distribution in the total study population were 88%, 82%, 66% and 53% after 1 year, and 78%, 66%, 50% and 30% after 2 years, respectively (P<0.001). The univariate hazard ratio of D-dimer (per double increase) for mortality was 1.5 (95% confidence interval: 1.4–1.6, P<0.001) and remained increased in multivariable analysis including tumor subgroups, age, sex and venous thromboembolism.

Conclusions
High D-dimer levels were associated with poor overall survival and increased mortality risk in cancer patients.
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