High Pretreatment Plasma D-dimer Levels Are Associated With Poor Prognosis in Patients With Ovarian Cancer Independently of Venous Thromboembolism and Tumor Extension

Trousseau reported an association between cancer and venous thromboembolism (VTE) in 1865, and activated coagulation and fibrinolysis in patients with malignant disease have recently been discovered.1,2 High D-dimer (DD) levels are a poor prognostic factor in patients with lung, prostate, cervical, breast, and colorectal cancer.3 Plasma DD levels (mean, 2.65 μg/mL) correlated with tumor volume, progression rate, and survival in 84 patients with metastatic breast cancer.4 Elevated plasma levels of DD (>0.65 μg/mL) were associated with decreased survival and a poor response to treatment in 78 patients with lung cancer.5 Survival was significantly shorter in a group with high DD levels (>0.85 μg/mL) among 96 patients with colon cancer, and the DD level was an independent prognostic factor in a multivariate analysis.6 However, the relationship between pretreatment DD levels and the survival of patients with ovarian cancer has not been elucidated. Plasma DD is generated via the degradation of fibrin by plasmin, and the level increases with enhanced fibrinolysis secondary to enhanced coagulation. Based on this mechanism, the plasma DD levels are used as an index to screen for deep vein thrombosis (DVT), with reported positive and negative predictive values of 36% to 44% and 89% to 100%, respectively.7–10 We showed that DD levels are useful in screening for VTE before treating ovarian, endometrial, and cervical cancers, and found that clear cell adenocarcinoma is a risk factor for VTE.11–13 The present study assesses relationships between pretreatment plasma DD levels and overall survival in patients with ovarian cancer.