Prognostic significance of pretreatment plasma D-dimer levels in patients with spinal chordoma: a retrospective cohort study
Plasma D-dimer levels, a marker of hypercoagulation, have not only been used as an indicator for cascaded reaction in the coagulation process but are also reported to be an underlying biomarker in several types of cancers. This retrospective cohort study was designed to evaluate the prognostic value of preoperative plasma D-dimer level in patients with spinal chordoma.
We enrolled 224 patients who underwent surgery for spinal chordoma between 2002 and 2015 at Changzheng Orthopedic Oncology Center. Preoperative clinical parameters were recorded and evaluated by univariate and multivariate Cox regression models. The correlation between preoperative plasma D-dimer levels and survival was assessed using the Kaplan–Meier method.
The optimal cutoff value of pretreatment D-dimer was 840 μg/L determined by X-tile. DFS (disease-free survival) was 64.7% and OS (overall survival) was 75% in the cohort. Multivariate Cox regression model identified D-dimer level as an independent prognostic factor of DFS and OS, as well as treatment history, preoperative Karnofsky Performance Scale, preoperative Frankel score, pathology classification and adjuvant radiotherapy (p < 0.05). In addition, D-dimer level may also be an effective supplement for defining tumor Enneking staging (p < 0.05).
Higher pretreatment plasma D-dimer level was associated with a poor prognosis in chordoma and could be used as an independent prognostic factor for the survival of the patients with spinal chordoma. With supplementation of D-dimer level, Enneking stage may be more able to accurate stratify individualized risk and determine clinical management.
KeywordsSpinal chordoma D-dimer Surgery Disease-free survival Overall survival
This study is supported by the National Natural Science Foundation of China (Grant No. 81702659).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
- 1.Healey JH, Lane JM (1989) Chordoma: a critical review of diagnosis and treatment. Orthop Clin North Am 20:417–426Google Scholar
- 4.Ailon T, Torabi R, Fisher CG, Rhines LD, Clarke MJ, Bettegowda C, Boriani S, Yamada YJ, Kawahara N, Varga PP, Shin JH, Saghal A, Gokaslan ZL (2016) Management of locally recurrent chordoma of the mobile spine and sacrum: a systematic review. Spine (Phila Pa 1976) 41(Suppl 20):S193–S198. https://doi.org/10.1097/brs.0000000000001812 CrossRefGoogle Scholar
- 7.Tai PT, Craighead P, Liem SK, Jo BH, Stitt L, Tonita J (2000) Management issues in chordoma: a case series. Clin Oncol (R Coll Radiol) 12:80–86Google Scholar
- 12.Pennicooke B, Laufer I, Sahgal A, Varga PP, Gokaslan ZL, Bilsky MH, Yamada YJ (2016) Safety and local control of radiation therapy for chordoma of the spine and sacrum: a systematic review. Spine (Phila Pa 1976) 41(Suppl 20):S186–S192. https://doi.org/10.1097/brs.0000000000001831 CrossRefGoogle Scholar
- 15.Meng T, Yin H, Li B, Li Z, Xu W, Zhou W, Cheng M, Wang J, Zhou L, Yang X, Liu T, Yan W, Song D, Xiao J (2015) Clinical features and prognostic factors of patients with chordoma in the spine: a retrospective analysis of 153 patients in a single center. Neuro-oncology 17:725–732. https://doi.org/10.1093/neuonc/nou331 CrossRefGoogle Scholar
- 16.Li W, Tang Y, Song Y, Chen SH, Sisliyan N, Ni M, Zhang H, Zeng Q, Hou B, Xie X, Chang D (2018) Prognostic role of pretreatment plasma d-dimer in patients with solid tumors: a systematic review and meta-analysis. Cell Physiol Biochem 45:1663–1676. https://doi.org/10.1159/000487734 CrossRefGoogle Scholar
- 17.Phillips RS, Wade R, Lehrnbecher T, Stewart LA, Sutton AJ (2012) Systematic review and meta-analysis of the value of initial biomarkers in predicting adverse outcome in febrile neutropenic episodes in children and young people with cancer. BMC Med 10:6. https://doi.org/10.1186/1741-7015-10-6 CrossRefGoogle Scholar
- 19.Hobusch GM, Bodner F, Walzer S, Marculescu R, Funovics PT, Sulzbacher I, Windhager R, Panotopoulos J (2016) C-reactive protein as a prognostic factor in patients with chordoma of lumbar spine and sacrum—a single center pilot study. World J Surg Oncol 14:111. https://doi.org/10.1186/s12957-016-0875-8 CrossRefGoogle Scholar
- 23.Motavaf E, Sunesen KG, Stender MT, Thorlacius-Ussing O (2014) Prognostic value of preoperative D-dimer and carcinoembryonic antigen levels in patients undergoing intended curative resection for colorectal cancer: a prospective cohort study. Int J Colorectal Dis 29:1427–1432. https://doi.org/10.1007/s00384-014-2000-1 CrossRefGoogle Scholar
- 34.Rickles FR, Edwards RL (1983) Activation of blood coagulation in cancer: Trousseau’s syndrome revisited. Blood 62:14–31Google Scholar