Novel high-sensitive D-Dimer determination predicts chemotherapy-associated venous thromboembolism in intermediate risk lung cancer patients

Patrizia Ferroni, Francesca Martini, Ilaria Portarena, Gioia Massimiani, Silvia Riondino, Francesca La Farina, Sabrina Mariotti, Fiorella Guadagni, Mario Roselli

Research output: Contribution to journalArticle

Abstract

Introduction: We hypothesized that the use of a novel high sensitivity (HS) assay for D-dimer determination might ameliorate venous thromboembolism (VTE) risk prediction in intermediate risk lung cancer patients in whom chemotherapy could act as a trigger for VTE onset. Patients and Methods: Pretreatment HS D-dimer levels were retrospectively evaluated in 108 lung cancer outpatients using a novel automated latex enhanced turbidimetric immunoassay. All patients were at the start of a new platinum-based chemotherapy regimen and were classified as intermediate risk according to Khorana's assessment model. Patients were followed-up for a median period of 6.9 months. Results: Receiver operating characteristic (ROC) curves and corresponding Bayesian analysis showed that the best performance was obtained at a cutoff level of 1500 ng/mL, which resulted in a sensitivity of 81%, a specificity of 69%, a positive predictive value (PPV) of 31%, a negative predictive value (NPV) of 96%, and an accuracy of 70%. Patients with HS D-dimer levels above the cutoff had a worse VTE-free survival (60%) compared with those with levels below the cutoff (95%; P =.0001). Multivariate Cox proportional hazards survival analysis confirmed that pretreatment HS D-dimer levels were able to significantly predict VTE with a hazard ratio of 11 (95% confidence interval, 2.62-46.2; P =.001), independently of classic VTE risk factors. Conclusions: The use of HS D-dimer determination prior to chemotherapy might allow for VTE risk stratification of intermediate risk cancer patients, helping in identifying those individuals who could benefit from thromboprophylaxis.

Original languageEnglish
Pages (from-to)482-487
Number of pages6
JournalClinical Lung Cancer
Volume13
Issue number6
DOIs
Publication statusPublished - Nov 2012

Keywords

  • Biomarkers
  • Coagulation
  • Risk assessment
  • Risk prediction
  • Thromboprophylaxis

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Pulmonary and Respiratory Medicine

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