Wang Zhen-Ni, Zhang Yao, Sun Jian, Zhao Zhen-Zhen, Wang Shan, Yang Chao
Department of Pediatric Surgical Oncology, Children's Hospital of Chongqing Medical University, Chongqing, China.
National International Science and Technology Cooperation Base for Critical Children's Developmental Diseases, Chongqing, China.
Ann Surg Treat Res. 2023 Sep;105(3):148-156. doi: 10.4174/astr.2023.105.3.148. Epub 2023 Sep 1.
Elevated plasma D-dimer level is a poor prognostic factor for many solid tumors. However, limited research has been conducted on D-dimer in children with neuroblastoma (NB), and its clinical significance remains unclear. The present study investigated the clinical and prognostic significance of D-dimer in pediatric NB patients.
A retrospective analysis of all newly admitted NB patients was conducted from January 2014 to December 2020. Baseline clinicopathological features, preoperative laboratory parameters, and follow-up information were collected. Univariate and multivariate analyses were performed to determine the relationship between D-dimer level, clinical features, and the prognostic value.
Among 266 patients, the median value of D-dimer was 2.98 ng/mL, of which 132 patients showed elevated D-dimer levels before surgery (>2.98 ng/mL). Univariate analysis revealed that elevated D-dimer was significantly associated with age, hemoglobin, neutrophil-to-lymphocyte ratio, neuron-specific enolase, 24-hour vanillylmandelic acid, overall survival, and so on (P < 0.05). Patients with elevated D-dimer levels had shorter median overall survival time when compared with normal D-dimer levels (P = 0.01). The prognosis was better in patients with normal D-dimer levels when combined with lower age, ganglioneuroblastoma tumor type, lower stage on International Neuroblastoma Staging System, low-risk group, and without bone metastasis or bone marrow metastasis. The continuous increase of D-dimer level after treatment indicated tumor recurrence or progression.
A high D-dimer level is associated with low overall survival, and an elevated D-dimer level after treatment indicates tumor recurrence and progression. D-dimer can be used as one of the evaluation factors for NB treatment or prognosis.
血浆D-二聚体水平升高是许多实体瘤预后不良的因素。然而，关于神经母细胞瘤（NB）患儿D-二聚体的研究有限，其临床意义仍不明确。本研究探讨了D-二聚体在小儿NB患者中的临床及预后意义。
对2014年1月至2020年12月所有新入院的NB患者进行回顾性分析。收集基线临床病理特征、术前实验室参数及随访信息。进行单因素和多因素分析以确定D-二聚体水平、临床特征与预后价值之间的关系。
266例患者中，D-二聚体的中位数为2.98 ng/mL，其中132例患者术前D-二聚体水平升高（>2.98 ng/mL）。单因素分析显示，D-二聚体升高与年龄、血红蛋白、中性粒细胞与淋巴细胞比值、神经元特异性烯醇化酶、24小时香草扁桃酸、总生存期等显著相关（P<0.05）。与D-二聚体水平正常的患者相比，D-二聚体水平升高的患者中位总生存时间较短（P = 0.01）。D-二聚体水平正常且年龄较小、神经节神经母细胞瘤肿瘤类型、国际神经母细胞瘤分期系统分期较低、低危组且无骨转移或骨髓转移的患者预后较好。治疗后D-二聚体水平持续升高表明肿瘤复发或进展。
高D-二聚体水平与低总生存期相关，治疗后D-二聚体水平升高表明肿瘤复发和进展。D-二聚体可作为NB治疗或预后的评估因素之一。
