Pretreatment Plasma D-Dimer, Fibrinogen, and Platelet Levels Significantly Impact Prognosis in Patients With Epithelial Ovarian Cancer Independently of Venous Thromboembolism

ObjectiveThe study aimed to evaluate the prognostic value of pretreatment plasma dimerized plasmin fragment D (D-dimer), fibrinogen, and platelet levels in epithelial ovarian cancer (EOC) after adjusting for venous thromboembolism (VTE) and to screen out the patients with the greatest risk for poor prognosis.MethodsThe study comprised 190 patients with EOC. The plasma D-dimer, fibrinogen, and platelet levels were examined before treatment and analyzed with patient clinicopathological parameters, progression-free survival (PFS), and overall survival (OS). The survival analysis was performed using the Kaplan-Meier method, and prognostic factors were assessed using the Cox proportional hazards regression model.ResultsThe incidences of elevated plasma D-dimer levels, hyperfibrinogenemia, and thrombocytosis were 40%, 42.11%, and 45.26%, respectively. Elevated plasma D-dimer level, hyperfibrinogenemia, and thrombocytosis were associated with advanced tumor stage (P< 0.001,P= 0.013,P< 0.001). In addition, the elevated plasma D-dimer levels were associated with macroscopic postoperative residual disease (P= 0.002) and VTE events (P= 0.006). In multivariate Cox regression model, plasma D-dimer, fibrinogen, and platelet levels were identified as independent prognostic factors for OS (P= 0.039,P= 0.002, andP= 0.049). However, plasma fibrinogen and platelet levels, but not D-dimer levels, had independent prognostic value for PFS (P= 0.012 andP= 0.022). Patients with at least any 2 abnormalities of plasma D-dimer, fibrinogen, and platelet levels showed shorter PFS and OS than did patients with at most 1 abnormality of 3 parameters (P< 0.001).ConclusionsPretreatment plasma D-dimer, fibrinogen, and platelet levels, which impact prognosis independently of VTE, were demonstrated to be potential markers to predict disease progression and surgery outcome in patients with EOC. The combined use of plasma D-dimer, fibrinogen, and platelet levels may help to identify the high-risk populations for treatment decisions.

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Evaluation of Risk Factors for Venous Thromboembolism in Chinese Women With Epithelial Ovarian Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e318276dd87 ◽

2013 ◽

Vol 23 (1) ◽

pp. 65-72 ◽

Cited By ~ 9

Author(s):

Xiangxiang Wu ◽

Xiang Xue ◽

Jie Tang ◽

Xi Cheng ◽

Wenjuan Tian ◽

...

Keyword(s):

Risk Factors ◽

Ovarian Cancer ◽

Venous Thromboembolism ◽

Epithelial Ovarian Cancer ◽

Chinese Women ◽

Cell Counting ◽

Chinese Patients ◽

Ca 125 ◽

Potential Risk Factors ◽

D Dimer

ObjectiveVenous thromboembolism (VTE) is a life-threatening complication that often occurs in ovarian tumors. However, the risk factors for VTE are still undetermined.MethodsWe retrospectively analyzed VTE occurrence and its potential risk factors in 254 Chinese patients with ovarian tumor at Fudan University Cancer Hospital from July 2007 to June 2011.ResultsThe VTE incidence was 7.1% (13/183) in epithelial ovarian cancer (EOC), and no VTE was found in ovarian borderline or benign tumor. D-dimer levels were significantly higher in EOC than in ovarian benign and borderline tumors. Furthermore, D-dimer levels increased with the advancement of EOC stages. Correlation analysis suggested that D-dimer levels were well correlated with platelet counting (PLT), prothrombin time (PT), white blood cell counting (WBC), cancer antigen (CA) 125, and CA153. Univariate logistic regression analysis found that D-dimer levels greater than 788 μg/L, PLT levels greater than 261 × 109/L, PT greater than 11.7 seconds, CA125 greater than 760 U/mL, and ascites greater than 1500 mL are risk factors for VTE in EOC. Moreover, multivariate analysis grouped primary EOC, low differentiated grade, D-dimer greater than 788 μg/L, PT greater than 11.7 seconds, and CA125 greater than 760 U/mL as prediction factors for VTE.ConclusionsIn addition to D-dimer and ascites, high levels of PLT, PT, and CA125, which are highly correlated with D-dimer, are independent risk factors for VTE

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Clinical significance for combined coagulation indexes in epithelial ovarian cancer prognosis

Journal of Ovarian Research ◽

10.1186/s13048-021-00858-1 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Jiani Yang ◽

Yue Jin ◽

Shanshan Cheng ◽

Chao Wang ◽

Nan Zhang ◽

...

Keyword(s):

Ovarian Cancer ◽

Prognostic Factors ◽

Epithelial Ovarian Cancer ◽

Predictive Value ◽

Roc Curves ◽

Coagulation System ◽

Ca 125 ◽

Poor Survival ◽

Platinum Based Chemotherapy ◽

D Dimer

Abstract Background Increasing evidence supported an association between cancer and coagulation system. We aimed to identify prognostic values of coagulation biomarkers in epithelial ovarian cancer (EOC). Methods A retrospective study was conducted on patients who underwent optimal tumor debulking followed by platinum-based chemotherapy at our institution. The predictive value of coagulation variables was evaluated by receiver operating characteristic (ROC) curves. Through Cox hazards regression models, prognostic factors were determined for recurrence-free survival (RFS) and overall survival (OS). Survival curves were visualized by Kaplan–Meier method and compared through Log-rank analysis. Results We involved 482 EOC patients and followed up for 64 (range, 36–87) months. According to ROC curves, D-dimer and International normalized ratio (INR) had superior predictive value than other coagulation indexes, with area under curve (AUC) of 0.758 and 0.742. Patients were then stratified into three combined D-dimer and INR (DD-INR) groups based on the cut-off value of 0.97 mg/L and 0.86, respectively. Through regression analysis, we demonstrated that age (HR 1.273; 95%CI 1.048–2.047; p = 0.045), pathological grade (HR 1.419; 95% CI 1.102–2.491; p = 0.032), clinical stage (HR 2.038; 95%CI 1.284–3.768; p = 0.008), CA-125 (HR 1.426; 95%CI 1.103–1.894; p = 0.038) and DD-INR (HR 2.412; 95%CI 1.683–3.241; p = 0.009) were independent prognostic factors. Survival analysis showed that patients with higher DD-INR experienced poor survival (p = 0.0013 for RFS and p = 0.0068 for OS). Further subgroup analysis revealed that evaluated DD-INR was significantly associated with poor survival among patients with advanced stage (p = 0.0028 for RFS and p = 0.0180 for OS). Conclusion Our findings suggested that coagulation indexes, especially the combined DD-INR were promising biomarkers for prognosis stratification in EOC patients, especially those with advanced clinical stages.

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Tissue factor pathway inhibitor 2 as a serum marker for diagnosing asymptomatic venous thromboembolism in patients with epithelial ovarian cancer and positive D‑dimer results

Molecular and Clinical Oncology ◽

10.3892/mco.2021.2479 ◽

2021 ◽

Vol 16 (2) ◽

Author(s):

Ryuta Miyake ◽

Yuki Yamada ◽

Shoichiro Yamanaka ◽

Ryuji Kawaguchi ◽

Norihisa Ootake ◽

...

Keyword(s):

Ovarian Cancer ◽

Venous Thromboembolism ◽

Epithelial Ovarian Cancer ◽

Tissue Factor ◽

Tissue Factor Pathway Inhibitor ◽

Serum Marker ◽

Tissue Factor Pathway ◽

D Dimer

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Incidence of venous thromboembolism among patients receiving neoadjuvant chemotherapy for advanced epithelial ovarian cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000980 ◽

2020 ◽

Vol 30 (4) ◽

pp. 491-497 ◽

Cited By ~ 3

Author(s):

Julia Rose Salinaro ◽

Kourtnie McQuillen ◽

Megan Stemple ◽

Robert Boccaccio ◽

Jessie Ehrisman ◽

...

Keyword(s):

Ovarian Cancer ◽

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Adjuvant Chemotherapy ◽

Neoadjuvant Chemotherapy ◽

Epithelial Ovarian Cancer ◽

Primary Outcome ◽

Vein Thrombosis ◽

Deep Vein

ObjectivesNeoadjuvant chemotherapy may be considered for women with epithelial ovarian cancer who have poor performance status or a disease burden not amenable to primary cytoreductive surgery. Overlap exists between indications for neoadjuvant chemotherapy and known risk factors for venous thromboembolism, including impaired mobility, increasing age, and advanced malignancy. The objective of this study was to determine the rate of venous thromboembolism among women receiving neoadjuvant chemotherapy for epithelial ovarian cancer.MethodsA multi-institutional, observational study of patients receiving neoadjuvant chemotherapy for primary epithelial ovarian, fallopian tube, or peritoneal cancer was conducted. Primary outcome was rate of venous thromboembolism during neoadjuvant chemotherapy. Secondary outcomes included rates of venous thromboembolism at other stages of treatment (diagnosis, following interval debulking surgery, during adjuvant chemotherapy, or during treatment for recurrence) and associations between occurrence of venous thromboembolism during neoadjuvant chemotherapy, subject characteristics, and interval debulking outcomes. Venous thromboembolism was defined as deep vein thrombosis in the upper or lower extremities or in association with peripherally inserted central catheters or ports, pulmonary embolism, or concurrent deep vein thrombosis and pulmonary embolism. Both symptomatic and asymptomatic venous thromboembolism were reported.ResultsA total of 230 patients receiving neoadjuvant chemotherapy were included; 63 (27%) patients overall experienced a venous thromboembolism. The primary outcome of venous thromboembolism during neoadjuvant chemotherapy occurred in 16 (7.7%) patients. Of the remaining venous thromboembolism events, 22 were at diagnosis (9.6%), six post-operatively (3%), five during adjuvant chemotherapy (3%), and 14 during treatment for recurrence (12%). Patients experiencing a venous thromboembolism during neoadjuvant chemotherapy had a longer mean time to interval debulking and were less likely to undergo optimal cytoreduction (50% vs 80.2%, p=0.02).ConclusionsPatients with advanced ovarian cancer are at high risk for venous thromboembolism while receiving neoadjuvant chemotherapy. Consideration of thromboprophylaxis may be warranted.

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