A high plasma D-dimer level predicts poor prognosis in gynecological tumors in East Asia area: a systematic review and meta-analysis

// Lei Xu 1, 2, * , Fan He 3, * , Hongcai Wang 2 , Bei Gao 4 , Huini Wu 5 and Shuping Zhao 1 1 Gynecology Department, Qingdao University Affiliated Qingdao Women’s and Children’s Hospital, Qingdao, China 2 Gynecology Department, Maternal and Child Health Hospital of Zibo City, Shandong, China 3 Department of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA 4 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China 5 Department of Biological Sciences, University of Illinois at Chicago, Chicago, IL, USA * These authors have contributed equally to this work Correspondence to: Shuping Zhao, email: zhaosp66@126.com Keywords: D-dimer, gynecological tumors, meta-analysis, prognosis Received: September 14, 2016 Accepted: February 15, 2017 Published: May 16, 2017 ABSTRACT High pre-treatment plasma D-dimer levels have been reported as a factor associated with a poor prognosis in different types of malignancies, including pancreatic, gastric, colorectal, lung, and nasopharyngeal carcinoma. Here, we performed a meta-analysis to determine the association of plasma D-dimer levels and long term survival in gynecological cancers, including ovarian, cervical and endometrial carcinoma. We searched all eligible publications in PubMed and Web of Science Databases up to August 2016. Primary outcomes, including overall survival (OS), disease-free survival and hazard ratios (HR) of were extracted and analyzed. Heterogeneity and publication bias were also assessed. A total of 7 eligible studies with 1112 cases were included in this study and all included studies are conducted in East Asia area. We found that gynecological cancer patients with high D-dimer demonstrates a much lower 5-year survival rate than those with low D-dimer levels (OR 4.12, 95% CI 3.04-5.58, P<0.00001). No significant heterogeneity is found (I 2 = 10 %; P = 0.35). Importantly, pooled analysis showed that high plasma D-dimer levels are predictive of a shorter OS in gynecological cancers (HR 2.09, 95% CI 1.59-2.74). No heterogeneity is observed (I 2 =5%, P=0.39). Additionally, a subgroup analysis of ovarian cancer is conducted. In conclusion, this meta-analysis showed that a high plasma D-dimer level predicts poor prognosis in gynecological tumors.