Original scientific article
Plasma D-Dimer Levels Show Correlation with Number of Lymph Node Metastases in Patients with Esophageal Cancer

https://doi.org/10.1016/j.jamcollsurg.2005.08.008Get rights and content

Background

Systemic activation of hemostasis and fibrolysis has been shown to be related to tumor progression in patients with malignancies such as lung cancer and colorectal cancer, but there has been no report of these clotting abnormalities in esophageal cancer. We investigated the clinical importance of measuring plasma levels of D-dimer (DD), which is a marker of the hypercoagulable stage, in preoperative patients with esophageal cancer.

Study design

Preoperative plasma DD levels were measured in 96 patients with primary esophageal cancer who were scheduled for esophagectomy with lymphadenectomy without preoperative treatment at our hospital. Results were correlated with the clinicopathological findings.

Results

Significantly different plasma DD levels were found with respect to histologic T (p = 0.0015), histologic N (p < 0.0001), number of metastastic nodes (p < 0.0001), and histologic stages (p < 0.0001). The number of lymph node metastases (0/1 to 3/4 to 7/8-) was found to have the strongest association with DD level among the significant clinicopathologic factors (Spearman rank correlation 0.591, p < 0.0001). The most useful cut-off level of the plasma DD levels for diagnosis of lymph node metastasis was determined to be 0.4 μg/mL, with specificity and sensitivity for lymph node metastasis being 62.9% and 88.2%, respectively.

Conclusions

Plasma DD levels are useful for assessing lymph node metastasis in patients with esophageal cancer and should be measured preoperatively.

Section snippets

Patients

Between January 2002 and December 2004, a total of 193 patients with esophageal cancer underwent esophagectomy with lymphadenectomy at the Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases. From this group, 96 were enrolled in this study, based on the following criteria: patients were primary cases and had received no earlier treatment, such as chemotherapy or radiotherapy. Curative resection was considered potentially possible by preoperative examinations.

Results

Clinicopathologic characteristics of the 96 patients, mostly men (88 of 96), are summarized in Table 1. From a histologic viewpoint, squamous cell carcinoma was predominant (89 of 96). Preoperative plasma DD, SCC-Ag, and CEA levels were compared among the subgroups of patients with various clinicopathologic characteristics (Table 2). There were no significant differences in the plasma DD levels based on gender, age, tumor location, tumor size, or the histologic type of the tumor. Plasma DD

Discussion

Hemostatic and fibrinolytic abnormalities have been reported to be correlated with tumor progression in various malignancies, including lung cancer, colorectal cancer, ovarian cancer, cervical cancer of the uterus, and prostate cancer.2, 3, 8, 9, 20, 21 Among the many hemostasis and fibrinolysis parameters, DD, a degradation product of fibrin, has recently attracted the attention of researchers in this field. Several studies reported that plasma DD levels can predict disease progression and

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    Competing Interests Declared: None.

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