European Spine Journal

, Volume 28, Issue 6, pp 1480–1490 | Cite as

Prognostic significance of pretreatment plasma D-dimer levels in patients with spinal chordoma: a retrospective cohort study

  • Bo Li
  • Hao Zhang
  • Pingting Zhou
  • Jiaxiang Yang
  • Haifeng Wei
  • Xinghai Yang
  • Cheng YangEmail author
  • Zhipeng WuEmail author
  • Jianru XiaoEmail author
Original Article



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.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Spinal 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.

Supplementary material

586_2018_5872_MOESM1_ESM.pptx (16 mb)
Supplementary material 1 (PPTX 16357 kb)
586_2018_5872_MOESM2_ESM.tif (44.9 mb)
Supplementary Figure. A typical case treated in our center. A male patient, 69 years old, suffering urination disorder and sphincter disturbances for 6 months had an en bloc surgery in our center and was diagnosed with chordoma by pathologists. (A) Plain radiographs of the patients; the typical bone erosion and tumor’s profiles can be observed. (B) Soft tissue invasion is obviously demonstrated on the magnetic resonance imaging (MRI). (C) Bone erosion was revealed by computed tomography (CT). (D) Intraoperative photograph of en bloc resection surgery; the tumor was removed integrally. (E) Comparison of the preoperational 3D-printing model and the tumor. (F) The post-surgery X-ray imaging shows that the sacrum was resected and the internal fixation was solid and successful. (TIFF 45944 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopedic Oncology, Changzheng HospitalSecond Military Medical UniversityShanghaiChina
  2. 2.Department of Radiation Oncology, Shanghai Ninth People’s HospitalShanghai Jiaotong University School of MedicineShanghaiChina
  3. 3.Anhui University of Chinese MedicineHefeiChina

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