Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
Anticancer Res. 2023 Jul;43(7):3173-3181. doi: 10.21873/anticanres.16491.
BACKGROUND/AIM: Pancreatic cancer cells release certain tissue factors into the bloodstream. It is well known that pancreatic cancer progresses with thrombus formation. Because we routinely measure serum D-dimer levels in preoperative patients as a screening marker of deep venous thrombosis, we examined its association with high serum D-dimer in our cohort of pancreatic cancer resected cases.
We examined 315 patients with pancreatic ductal adenocarcinoma who underwent surgical resection in our department from January 2012 to July 2021. All cases were divided into high D-dimer cases (n=118) and low D-dimer cases (n=197) using the cut-off value of 1.0 μg/ml, an institutional upper limit. Clinicohistological characteristics and postoperative survival outcomes were evaluated.
Preoperative high D-dimer cases showed significantly worse progression-free survival (PFS) (p=0.021) and overall survival (OS) (p=0.027) than low D-dimer cases; median PFS was 13.9 months versus 21.4 months, and that of OS was 33.4 months versus 68.0 months. Clinicohistological characteristics of high D-dimer cases were age over 70 years (p<0.001), pathological portal vein invasion (p=0.003), and initially borderline resectable or unresectable cases (p=0.027). Multivariate analysis indicated that preoperative high D-dimer was a significant prognostic factor of PFS (hazard ratio=1.42, p=0.025) and OS (hazard ratio=1.51, p=0.036).
Preoperative high serum D-dimer over 1.0 μg/ml was associated with pathological portal vein invasion and could be an unfavorable prognostic marker of PFS and OS after surgery, typically due to distant metastasis.
背景/目的：胰腺癌细胞会将某些组织因子释放到血液中。众所周知，胰腺癌的进展伴随着血栓形成。由于我们在术前常规测量患者的血清 D-二聚体水平作为深静脉血栓形成的筛查标志物，因此我们在接受手术切除的胰腺癌患者队列中检查了其与高血清 D-二聚体的相关性。
我们检查了 2012 年 1 月至 2021 年 7 月期间在我院接受手术切除的 315 例胰腺导管腺癌患者。所有病例均根据 1.0μg/ml 的截断值（本机构上限）分为高 D-二聚体组（n=118）和低 D-二聚体组（n=197）。评估了临床病理特征和术后生存结果。
术前高 D-二聚体组的无进展生存期（PFS）（p=0.021）和总生存期（OS）（p=0.027）明显更差；中位 PFS 为 13.9 个月与 21.4 个月，OS 为 33.4 个月与 68.0 个月。高 D-二聚体组的临床病理特征为年龄大于 70 岁（p<0.001）、病理门静脉侵犯（p=0.003）和最初边界可切除或不可切除的病例（p=0.027）。多变量分析表明，术前高 D-二聚体是 PFS（风险比=1.42，p=0.025）和 OS（风险比=1.51，p=0.036）的显著预后因素。
术前血清 D-二聚体超过 1.0μg/ml 与病理门静脉侵犯有关，可能是术后 PFS 和 OS 的不利预后标志物，通常是由于远处转移所致。
