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D‐dimers in malignant melanoma: Association with prognosis and dynamic variation in disease progress
Author(s) -
Desch Anna,
Gebhardt Christoffer,
Utikal Jochen,
Schneider Stefan W.
Publication year - 2016
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.30498
Subject(s) - melanoma , disease , medicine , variation (astronomy) , malignant disease , oncology , association (psychology) , cancer , cancer research , psychology , physics , astrophysics , psychotherapist
Malignant cells elicit a chronic hemostatic activation in disease progress. This procoagulant activity does not only bear a risk for thromboembolism but also facilitates tumor growth and dissemination. An elevated plasma D‐dimer level indicates an activated coagulation and fibrinolysis. In this study, the association of D‐dimer levels with clinicopathological parameters and patients outcome in melanoma was investigated analyzing in total 533 melanoma patients retrospectively. Using the cut‐off point of 0.6 mg/L D‐dimer 145 of the total 533 patients (27.2%) were identified with elevated plasma D‐dimer levels. This increased D‐dimer level positively correlated with tumor thickness ( p = 0.0003), lymph node invasion ( p = 0.0004) and metastatic state ( p <0.0001). To assess the association of D‐dimer levels with progression‐free survival (PFS) and overall survival (OS), long‐rank test and the Cox proportional hazard model was performed. Univariate analyses revealed that elevated D‐dimer levels were significantly associated with decreased PFS (HR:2.89, 95% CI (2.07‐7.56), p < 0.0001) and OS (HR:2.22, 95% CI (1.06‐4.57), p = 0.035). Moreover, multivariate analyses identified elevated D‐dimer levels being associated with poor disease outcome (PFS:HR:2.47, 95% CI (1.23‐4.98), p = 0.012; OS:HR:2.01, 95% CI (0.09‐4.45), p = 0.087). Additionally, D‐dimer levels were significantly increased in terminal stage patients when comparing plasma levels 0‐8 versus 24‐48 weeks before death ( p = 0.0003). In summary, this study presents multiple evidence that elevated D‐dimer levels in melanoma patients associate with poor prognosis and therefore plasma levels of D‐dimers could reveal a more aggressive phenotype of melanoma and may guide the management of anti‐melanoma treatment including the concept of an anti‐coagulatory therapy in tumor patients.