Impact of pretreatment plasma D-dimer levels and its perioperative change on prognosis in operable esophageal squamous cell carcinoma

The aim of this study was to investigate the relationship between plasma D-dimer levels and its perioperative change and clinicopathological parameters in patients with operable esophageal squamous cell carcinoma (ESCC). We also analyzed their prognostic significance in ESCC patients. The data of 294 ESCC patients between December 2007 and December 2012 in Mingzhou hospital, Ningbo, China were analyzed retrospectively. Plasma D-dimer levels were measured one week before surgery and on the thirtieth postoperative day. The association between plasma D-dimer levels and clinicopathological parameters was evaluated. Kaplan-Meier survival analysis and Cox proportional hazards models were used to estimate the effect of plasma D-dimer levels and its perioperative change on disease-free survival (DFS) and overall survival (OS). Plasma D-dimer levels were above 0.5 µg/mL in 148 patients (50.3%). Plasma D-dimer levels were significantly related with DFS (P < 0.001) and OS (P < 0.001) in univariate analysis. There was significant relationship between plasma D-dimer levels and DFS in patients with N(0) (P < 0.001) or N(+) (P = 0.003). Multivariate analysis revealed that plasma D-dimer levels (P < 0.001), sex (P = 0.012), and T stage (P = 0.033) were independent prognostic factors for DFS. Tumor length (P = 0.018), T stage (P = 0.008) and plasma D-dimer levels (P = 0.001) qualified as independent prognostic factors for OS. Our study suggests that pretreatment plasma D-dimer levels is a powerful independent prognostic factor for operable ESCC. Further studies are needed to prospectively validate this prognostic model and investigate the mechanisms underlying the correlation between elevated plasma D-dimer levels and poor prognosis in operable ESCC.