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Postoperative D-dimer elevation affects tumor recurrence and the long-term survival in gastric cancer patients who undergo gastrectomy

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Abstract

Introduction

We retrospectively evaluated the blood coagulation activity using the D-dimer level in the early period after gastrectomy and investigated whether postoperative hypercoagulation affects tumor recurrence and long-term survival in gastric cancer patients.

Methods

The study involved 650 patients who underwent curative resection for gastric cancer at Kanagawa Cancer Center between July 2009 and July 2013. They were divided into a low-D-dimer group (LD group) and high-D-dimer group (HD group) according to the median D-dimer level on postoperative day (POD) 7. The risk factors for overall survival (OS) and relapse-free survival (RFS) were identified.

Results

Of the 448 enrolled patients, 218 were classified into the LD group and 230 into the HD group. The 5-year OS rates after surgery were 90.8% and 81.3% in the LD and HD groups, respectively (p < 0.001). The 5-year RFS rates after surgery were 89.9% and 76.1% in the LD and HD groups, respectively (p < 0.001). A high D-dimer level on POD 7 (≥ 4.9 μg/ml) was identified as an independent predictive factor for both the OS (hazard ratio [HR] 1.955, 95% confidence interval [CI] 1.158–3.303, p = 0.012) and RFS (HR 2.182, 95% CI 1.327–3.589, p = 0.002). Furthermore, hematological recurrence was significantly more frequent in the HD group than in the LD group (p = 0.014).

Conclusion

A high D-dimer level on POD 7 may predict tumor recurrence and the long-term survival in patients who undergo gastrectomy for locally advanced gastric cancer. Patients with an elevated postoperative D-dimer level need careful observation and diagnostic imaging to timely detect tumor recurrence.

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Acknowledgements

This work was supported, in part, by the non-governmental organization Yokohama Surgical Research Group, Dr. Masumi Kamachi (Tokyo Shinagawa Hospital), Dr. Ryuji Tominaga (Fukuoka Wajiro Hospital), Dr. Nobuko Yoshiki (Yoshiki Dermatology Clinic Ginza). The authors express their sincere gratitude to Ms. Natsumi Sato and Ms. Rika Takahashi for their excellent data management in this study.

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Author notes

  1. Kentaro Hara and Toru Aoyama equally contributed to this article.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan

    Kentaro Hara, Tsutomu Hayashi, Masato Nakazono, Shinsuke Nagasawa, Yota Shimoda, Yuta Kumazu, Takanobu Yamada, Manabu Shiozawa, Soichiro Morinaga, Takashi Ogata & Takashi Oshima

  2. Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Toru Aoyama, Masakatsu Numata, Hiroshi Tamagawa, Norio Yukawa, Yasushi Rino & Munetaka Masuda

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  1. Kentaro Hara
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Correspondence to Takashi Oshima.

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Hara, K., Aoyama, T., Hayashi, T. et al. Postoperative D-dimer elevation affects tumor recurrence and the long-term survival in gastric cancer patients who undergo gastrectomy. Int J Clin Oncol 25, 584–594 (2020). https://doi.org/10.1007/s10147-019-01603-x

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  • DOI: https://doi.org/10.1007/s10147-019-01603-x

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