Serum d-dimer as a prognostic marker in patients undergoing radiofrequency ablation of colorectal liver metastasis.
Endocrinology and Metabolism Institute, Division of Endocrine Surgery , Cleveland Clinic, Cleveland, OH , USA.
ABSTRACT Background: Although traditionally used for coagulation disorders, there has been a recent interest in serum D-dimer as a tumor marker. The aim of this prospective study is to determine its value as a tumor marker in patients with colorectal liver metastasis. Patients and Methods: Between January 2000 and October 2007, 242 patients undergoing laparoscopic radiofrequency ablation (RFA) of colorectal liver metastasis were evaluated prospectively. The relationship of D-dimer levels to pre-ablation parameters, recurrence, and survival was prospectively assessed. All data are expressed as mean ± SEM. Results: Preoperative D-dimer levels correlated with liver tumor volume (p = .04) and CEA (p = .003). D-dimer levels increased by a mean of 11.4 ± 1.5 folds after RFA on POD#7 and returned to preoperative values in three months. The rate of the elevation of D-dimer values after RFA was related to tumor volume ablated. The median overall survival was six months for patients with preoperative D-dimer > 1,000 ng/ml vs. 32 months for patients with D-dimer < 1,000 ng/ml (p = .02). On multivariate analysis preoperative serum D-dimer was an independent predictor of overall survival along with CEA and liver tumor burden. Conclusion: Serum D-dimer levels reflect liver tumor burden and independently predict survival in patients with colorectal liver metastasis undergoing RFA.