Lung Cancer Center, West China Hospital, Sichuan University, Chengdu.
Department of Thoracic Surgery, Suining Central Hospital, Suining, PR China.
Medicine (Baltimore). 2021 Apr 16;100(15):e25447. doi: 10.1097/MD.0000000000025447.
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.
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.
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.
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.
小细胞肺癌（SCLC）患者常伴有高预处理 D-二聚体水平，但高预处理 D-二聚体水平对 SCLC 患者预后的影响仍不确定。因此，我们进行了这项荟萃分析，专门关注高预处理 D-二聚体水平对 SCLC 患者预后的预测价值。
我们系统地检索了 PubMed、Embase 和 Web of Science 数据库，以获取截至 2019 年 1 月 28 日之前发表的相关研究。提取并分析了来自多变量分析的 1 年总生存率（OS）、无进展生存率（PFS）率以及 OS 和 PFS 的风险比（HR）。
最终纳入了 5 项队列研究，共 813 例 SCLC 患者（473 例高预处理 D-二聚体水平患者和 340 例正常 D-二聚体水平患者）进行荟萃分析。我们发现，高预处理 D-二聚体水平患者的 1 年 OS（47.6% vs 79.9%；固定效应：风险比 [RR] = 2.506；95%置信区间 [CI] = [1.948, 3.224]；P < .001）和 PFS（15.8% vs 34.0%；随机效应：RR = 1.294；95% CI = [1.060, 1.579]；P = .011）率明显低于 D-二聚体水平正常患者。此外，高预处理 D-二聚体水平进一步被证明是 OS（固定效应：HR = 1.865；95% CI = [1.469, 2.367]；P < .001；I2 = 7.6%）和 PFS（固定效应：HR = 1.513；95% CI = [1.183, 1.936]；P = .001；I2 = 0.0%）的不良预后因素。
高预处理 D-二聚体水平是 SCLC 患者独立的不良预后因素。然而，需要更多充分调整混杂因素的研究来证实我们的结论。
