A Novel Clinical Factor, D-Dimer Platelet Multiplication, May Predict Postoperative Recurrence and Prognosis for Patients with Cholangiocarcinoma.

Abstract

Patients with cholangiocarcinoma (CC) have a poor prognosis, and their postoperative survival depends on cancer progression and recurrence. Thus, prognostic markers are needed. The fibrin cleavage product, D-dimer, is associated with malignant progression and recurrence in various cancers, and platelets also are related to tumor progression. This study therefore evaluated a new prognostic factor, D-dimer platelet multiplication (PDM), for predicting prognosis in cases of CC. This study retrospectively evaluated 55 cases to determine the correlations of D-dimer, platelet, and PDM levels with patient survival. The cutoff values for D-dimer, platelets, and PDM levels were determined using receiver operating characteristic curve analyses. The recurrence group exhibited significantly higher D-dimer (P = 0.00075) and PDM (P = 0.0000683) levels and a trend toward higher platelet levels (P = 0.117). The optimal cutoff values were 1.3 µg/mL for D-dimer levels, 245 × 104/µL for platelet levels, and 158.2 × 104 µg/mL × µL for PDM levels. Poor recurrence-free survival was associated with high D-dimer levels (P = 0.0428), high platelet levels (P = 0.0498), and high PDM levels (P = 0.00511). Poor cancer-specific survival was associated with high platelet levels (P = 0.0156) and high PDM levels (P = 0.0156). In the multivariate analysis, PDM had the greatest correlation with CC prognosis and independently predicted recurrence (P = 0.00649). High D-dimer, platelet, and PDM levels were associated with poor recurrence-free and cancer-specific survivals, with PDM exhibiting the greatest correlation with prognosis. Therefore, PDM may help to predict recurrence and prognosis for patients with CC.