ABSTRACT
BACKGROUND: Fibrin formation is required for tumor angiogenesis, metastasis and invasion. Cancer discovered at the same time as or shortly after venous thromboembolism (VTE) tends to be advanced, and the prognosis poor. Previous studies have demonstrated that plasma D-dimer - a degradation product of cross-linked fibrin - correlates with tumor stage and prognosis in patients with colorectal cancer. However, it remains unclear whether D-dimer is of prognostic significance in colorectal cancer patients with absence of VTE. OBJECTIVE: To examine whether the preoperative plasma D-dimer level predicts 1-year survival in pre- and postoperative VTE-negative colorectal cancer patients admitted for surgery. METHODS: We measured preoperative D-dimer levels in 157 patients, and computed Kaplan-Meier survival curves according to the levels of D-dimer. Cox proportional-hazard regression analysis was used to compute hazard ratio as a measure of 1-year mortality rate ratio, controlling for potential confounding factors. The Aalborg Hospital's standard cut-off level of 0.3 mg L(-1) was used to distinguish negative and positive D-dimer results. RESULTS: The overall 1-year survival rate was 87.3% (95% confidence interval (CI), 81.0-91.6%), with 78.1% survival (95% CI, 65.9-86.4%) in the positive D-dimer group compared with 93.6% survival (95% CI, 86.2-97.1%) in the negative D-dimer group. The adjusted hazard ratio of death in the positive D-dimer group compared with the negative D-dimer group was 3.6 (95% CI, 1.3-9.9). CONCLUSION: A positive preoperative D-dimer is associated with a poor prognosis in colorectal cancer patients with absence of VTE.
Subject(s)
Colectomy , Colorectal Neoplasms/surgery , Fibrin Fibrinogen Degradation Products/analysis , Venous Thromboembolism/blood , Adult , Aged , Aged, 80 and over , Biomarkers/blood , Colectomy/adverse effects , Colectomy/mortality , Colonoscopy , Colorectal Neoplasms/blood , Colorectal Neoplasms/mortality , Colorectal Neoplasms/pathology , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Neoplasm Recurrence, Local , Neoplasm Staging , Predictive Value of Tests , Preoperative Period , Proportional Hazards Models , Prospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Venous Thromboembolism/mortalityABSTRACT
BACKGROUND: Deep venous thrombosis (DVT) is a major complication of cancer and a predictor of reduced survival. The postoperative prevalence of DVT in colorectal cancer surgery is high, but the preoperative prevalence is unknown. The aim of this observational study was to estimate the preoperative prevalence of DVT in patients with colorectal cancer. METHODS: Some 193 consecutive patients with newly diagnosed colorectal cancer admitted for intended curative surgery were examined with compression ultrasonography for DVT before surgery. RESULTS: DVT was detected in 15 (7.8 per cent) of the 193 patients, with a prevalence of 16 per cent in women (12 of 76) versus 2.6 per cent in men (three of 117 (adjusted odds ratio (OR) 5.8 (95 per cent confidence interval (c.i.) 1.4 to 23.2)). The risk of DVT was strongly correlated with increasing American Society of Anesthesiologists (ASA) risk score: adjusted OR 6.8 (95 per cent c.i. 1.6 to 28.7 for ASA group III or IV versus ASA group I or II). Pulmonary embolism was detected in two patients (1.0 per cent). CONCLUSION: A high preoperative prevalence of DVT was observed in patients with colorectal cancer, especially among women and patients in ASA groups III and IV.
